Kevin T Cannon, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

11371 Issued in MA

Practice address

3 Dundee Park Dr Ste 203
Andover, MA 01810-3723

Phone

(978) 655-2252

Fax

(978) 296-5594

NPI assigned

May 29, 2018

Last updated

Feb 13, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Integrated Behavioral Care New England LLCGroup PAC ID 2860836715, 26 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Integrated Behavioral Care New England LLC

  • Counselor
  • North Andover, MA
  • NPI 1053185272

  Clinical

  Medicare reassignment Care Compare group NPD
• General Psychological Associates

  • Counseling Psychologist
  • Andover, MA
  • NPI 1700810025
  NPD
• Lamora Psychological Associates, P.a.

  • Clinical Psychologist
  • Nashua, NH
  • NPI 1407876253
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1527552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739404800000",
    "number": "1023509825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 LINDEN ST",
            "city": "HUDSON",
            "state": "NH",
            "postal_code": "030514781",
            "telephone_number": "603-438-3523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 DUNDEE PARK DR STE 203",
            "city": "ANDOVER",
            "state": "MA",
            "postal_code": "018103723",
            "telephone_number": "978-655-2252",
            "fax_number": "978-296-5594"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10 Federal St Ste 307",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "MA",
            "postal_code": "019703860",
            "country_code": "US",
            "telephone_number": "617-758-8485 x126",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "39 Simon St Ste 5",
            "address_purpose": "LOCATION",
            "city": "Nashua",
            "state": "NH",
            "postal_code": "030603045",
            "country_code": "US",
            "telephone_number": "603-889-8648",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CANNON",
        "first_name": "KEVIN",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-29",
        "last_updated": "2025-02-13",
        "certification_date": "2025-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "MA",
            "license": "11371",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MA",
            "license": "11371",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ellen Grace Callahan, CPNP
• Richard A Campbell, CRNA
• Campromo Partners LLC (Angel Home Care)
• Barbara O'Malley Cannon, PH.D., BCBA
• Bonnie L. Cannon, LICSW
• Nancy B Caporello, LEP
• Kellie J Capra, RN
• Care for You, Inc. (Griswold Home Care)
• Care24 Home Health Services
• Carefree Pharmacy Inc. (Carefree Chronic Care)

• Clinical Psychologist in Andover, MA
• Providers in Andover, MA by specialty
• Clinical Psychologist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.