Jean S Cannon, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PS015850 Issued in PA

Practice address

1681 Crown Ave
Suite 11
Lancaster, PA 17601-6303

Phone

(717) 393-9388

Fax

(717) 393-9389

NPI assigned

May 5, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Jean Elizabeth Stevens Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

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

• Jean S. Cannon, Psy.D., Inc

  • Clinic/Center
  • Lancaster, PA
  • NPI 1629231261
  NPD (past) Authorized official

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1300320000000",
    "number": "1104874445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1681 CROWN AVE",
            "address_2": "SUITE 11",
            "city": "LANCASTER",
            "state": "PA",
            "postal_code": "176016303",
            "telephone_number": "717-393-9388",
            "fax_number": "717-393-9389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1681 CROWN AVE",
            "address_2": "SUITE 11",
            "city": "LANCASTER",
            "state": "PA",
            "postal_code": "176016303",
            "telephone_number": "717-393-9388",
            "fax_number": "717-393-9389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANNON",
        "first_name": "JEAN",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-05-05",
        "last_updated": "2011-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "PA",
            "license": "PS015850",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101535870-0001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIEL",
            "identifier": "CA1850139",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JEAN",
            "last_name": "STEVENS",
            "middle_name": "ELIZABETH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Campus Wellness Partners
• Cancer Care for Women PC
• Shannon Canning
• Amy Cannon, LPC
• Andrew Scott Cannon, PT
• Jessica Michelle Cannon, MS, RDN, LDN
• Katelyn Cannon
• Rotilio P Canosa, DO
• Cantwell Dental Group LTD
• Capable Care Solutions LLC

• Clinical Psychologist in Lancaster, PA
• Providers in Lancaster, PA by specialty
• Clinical Psychologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.