| Doctor Name: | MS. JILL CANNON |
| NPI Number: | 1225003379 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | 0190571 |
| Business Practice Address: | 130 Allison Rd Katonah, NY - 105363430 |
| Business Phone Number: | 9144019010 |
| Business Fax Number: | 9144019009 |
| Mailing Address: | 130 Allison Rd, KATONAH |
| State: | NY |
| Postal Code: | 105363430 |
| Phone Number: | 9144019010 |
| Fax Number: | 9144019009 |
| NPI Enumeration Date: | 02/22/2006 |
| NPI Last Update Date: | 10/23/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TA0400X |
| License Number: | 0190571 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |