| Doctor Name: | MS. MARY ELIZABETH CANNON |
| NPI Number: | 1164593661 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LMHC,CRC,CASAC |
| License Number: | 002860-1 |
| Business Practice Address: | 69 Surfside Ave Montauk, NY - 119540896 |
| Business Phone Number: | 6312385060 |
| Business Fax Number: | 6312385060 |
| Mailing Address: | Po Box 1300, 69 Surfside Ave MONTAUK |
| State: | NY |
| Postal Code: | 119540896 |
| Phone Number: | 6312385060 |
| Fax Number: | 6312385060 |
| NPI Enumeration Date: | 11/13/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 002860-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |