Organization
JEAN S. CANNON, PSY.D., INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEAN S. CANNON PSY.D. (PRESIDENT)
(717) 393-9388
Entity
Organization
Contact information
Practice address
1681 CROWN AVE, SUITE 11, LANCASTER, PA 17601-6303
(717) 393-9388
Mailing address
1681 CROWN AVE, SUITE 11, LANCASTER, PA 17601-6303
(717) 393-9388
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101535870-0001
—
PA
01
—
1558528
GATEWAY MEDICARE ASSURED
PA
01
—
4101535870
CBHNP
PA
01
—
CA1850139
HIGHMARK BLUE SHIELD
PA
Enumeration date
07/03/2008
Last updated
03/17/2011
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