Active NPI
Carol W. Cannon, LICSW
- Clinical Social Worker
- Mobile, AL
National Provider Identifier
1154993418
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 1064C
- Practice address
- 251 N Bayou St
Mobile, AL 36603-5827 - Phone
- (251) 690-8158
- NPI assigned
- Jul 15, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 1064C | AL | Primary |
Addresses
Primary practice location
251 N Bayou St
Mobile, AL 36603-5827
Mailing address
251 N Bayou St
Mobile, AL 36603-5827
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 276301 | Medicaid | AL | |
| 275693 | Medicaid | AL | |
| 276253 | Medicaid | AL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1064C | AL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1626307200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1640822400000",
"number": "1154993418",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "251 N BAYOU ST",
"city": "MOBILE",
"state": "AL",
"postal_code": "366035827"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "251 N BAYOU ST",
"city": "MOBILE",
"state": "AL",
"postal_code": "366035827",
"telephone_number": "251-690-8158"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CANNON",
"first_name": "CAROL",
"middle_name": "W.",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-07-15",
"last_updated": "2021-12-30",
"certification_date": "2021-12-30",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "AL",
"license": "1064C",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "276301",
"state": "AL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "275693",
"state": "AL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "276253",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mobile, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.