Doctor Name: | LISA CANNON |
NPI Number: | 1861809832 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | 34007012A |
Business Practice Address: | 1265 N Bradford Dr Delphi, IN - 469239553 |
Business Phone Number: | 7655642247 |
Business Fax Number: | |
Mailing Address: | 1265 N Bradford Dr, DELPHI |
State: | IN |
Postal Code: | 469239553 |
Phone Number: | 4124187731 |
Fax Number: | |
NPI Enumeration Date: | 07/22/2014 |
NPI Last Update Date: | 07/22/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 34007012A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |