Doctor Name: | MS. ROSE MARY CANNON |
NPI Number: | 1235423799 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSW |
License Number: | 6801057224 |
Business Practice Address: | 1200 E 12 Mile Rd Madison Hts, MI - 480712652 |
Business Phone Number: | 2486581116 |
Business Fax Number: | 2486581120 |
Mailing Address: | 7463 Gerald Ave, WARREN |
State: | MI |
Postal Code: | 480923917 |
Phone Number: | 5862920648 |
Fax Number: | |
NPI Enumeration Date: | 06/01/2011 |
NPI Last Update Date: | 06/01/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 6801057224 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |