Tucker Croxall Cannon, LCSW

Primary specialty

School Social WorkerTaxonomy code 1041S0200X

License

28707 Issued in CA

Practice address

2046 Allen Ave RM 100
Altadena, CA 91001-3424

Phone

(626) 660-9419

NPI assigned

Mar 14, 2007

Last updated

Nov 2, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Cannon Therapeutic

  • Clinical Social Worker
  • Midway, UT
  • NPI 1497624951
  NPD Authorized official

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

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1351814400000",
    "number": "1205969623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 MAIN ST. SUITE 4091",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926619998",
            "telephone_number": "949-244-9982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2046 ALLEN AVE RM 100",
            "city": "ALTADENA",
            "state": "CA",
            "postal_code": "910013424",
            "telephone_number": "626-660-9419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANNON",
        "first_name": "TUCKER",
        "middle_name": "CROXALL",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-14",
        "last_updated": "2012-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "28707",
            "primary": false
        },
        {
            "code": "1041S0200X",
            "taxonomy_group": "",
            "desc": "Social Worker, School",
            "state": "CA",
            "license": "18784",
            "primary": false
        },
        {
            "code": "1041S0200X",
            "taxonomy_group": "",
            "desc": "Social Worker, School",
            "state": "CA",
            "license": "28707",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maureen Butler
• Laura Gina Calderoni
• California Health Psychology PC
• Bradley David Campbell, DDS
• David Stuart Campbell, D.D.S.
• Adriana Evette Caridad
• Caring Touch Hospice Incorporated
• Steven Ross Carter, MFT
• Todd Laron Caruthers
• Nancy Casillas

• School Social Worker in Altadena, CA
• Providers in Altadena, CA by specialty
• School Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2012; 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.