Jill Cannon, LCSW
Individual provider Active NPI Clinical Social Worker · Katonah, NY
NPI 1225003379 · NPPES record last updated Oct 23, 2009
Key facts
- NPI
- 1225003379
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 0190571 (NY)
- Practice address
- 130 Allison Rd
Katonah, NY 10536-3430 - Phone
- (914) 401-9010
- Fax
- (914) 401-9009
- NPI assigned
- Feb 22, 2006
- Sex
- Female
- Sole proprietor
- Yes
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 1977
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
16 Rockledge Ave
Apt 2M2
Ossining, NY 10562-6687
Phone (914) 901-9010
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20071212000317 | NY | Practitioner - Clinical Social Worker | 8729178967 | Practice locations: Ossining, NY |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R#019571 | NY | MD | Psychologist |
| 0190571 | NY | MD | Forensic Psychologist |
| 019571 | NY | MD | Group Psychotherapy Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Psychologist | 103TA0400X | 0190571 | NY | |
| Psychologist | 103T00000X | R#019571 | NY | |
| Clinical Psychologist | 103TC0700X | 0190571 | NY | |
| Family Psychologist | 103TF0000X | 0190571 | NY | |
| Forensic Psychologist | 103TF0200X | 0190571 | NY | |
| Clinical Social Worker | 1041C0700X | 0190571 | NY | Yes |
| Group Psychotherapy Psychologist | 103TP2701X | 019571 | NY |
Addresses
Primary practice location
130 Allison Rd
Katonah, NY 10536-3430
Mailing address
130 Allison Rd
Katonah, NY 10536-3430
Phone (914) 401-9010
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 140019057NY01 | Other | ANTHEM | |
| 135497 | Other | VALUE OPTIONS |
Other providers in Katonah, NY
- Kim Ann Breihof
- Lauren Budow
- Sergio Bures
- Robie Burke
- Frank Calo
- Marlene Carneiro
- Carolyn D. Greene Psy.D., P.C.
- Debra Ann Carpenter
- Rosemary Elizabeth Carro
- Davina Chanta Carter
All providers in Katonah, NY · Clinical Social Worker in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 23, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.