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General NPI Number Information
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NPI Number | 1023509825
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Entity Type | Individual
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Provider Name | KEVIN T CANNON PH.D.
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Gender | Male
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Dates
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Enumeration Date | 05/29/2018
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 3 DUNDEE PARK DR STE 203
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City | ANDOVER
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State | MA
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Zip | 01810-3723
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Country | US
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Telephone | 978-655-2252
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Fax | 978-296-5594
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Provider Business Mailing Address
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Address Line | 5 LINDEN ST
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City | HUDSON
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State | NH
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Zip | 03051-4781
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Country | US
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Telephone | 603-438-3523
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 11371
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 11371
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License Number State | MA
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