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General NPI Number Information
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NPI Number | 1184886566
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Entity Type | Individual
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Provider Name | REBECCA CANNA PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 06/27/2008
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Last Update Date | 06/27/2008
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Provider Practice Location Address
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Address Line | 1225 VINE ST 3RD FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19107-1116
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Country | US
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Telephone | 215-304-0680
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Fax |
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Provider Business Mailing Address
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Address Line | 211 LAZARETTO RD 12 G
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City | PROSPECT PARK
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State | PA
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Zip | 19076-1835
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Country | US
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Telephone | 610-304-0680
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS016417
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License Number State | PA
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