Alicia Cannon, PH.D.

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

05106 Issued in MD

Practice address

1750 E Fairmount Ave
Baltimore, MD 21231-1534

Phone

(443) 923-4442

Fax

(443) 923-4403

NPI assigned

Mar 30, 2011

Last updated

Dec 28, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other names 1

• Alicia Fields Former name

Medicare fee-for-service enrollment

Enrolled in MD

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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.

• Kennedy Krieger Associates

  • Pediatrics Physician
  • Baltimore, MD
  • NPI 1871515783
  Medicare reassignment NPD
• Fields Neuropsychology Services, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Pikesville, MD
  • NPI 1427308063
  NPD
• Kennedy Krieger Associates

  • Pediatrics Physician
  • Middle River, MD
  • NPI 1841009842
  NPD

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

{
    "created_epoch": "1301443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703721600000",
    "number": "1316236326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1750 E FAIRMOUNT AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212311534",
            "telephone_number": "443-923-4442",
            "fax_number": "443-923-4403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1750 E FAIRMOUNT AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212311534",
            "telephone_number": "443-923-4442",
            "fax_number": "443-923-4403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANNON",
        "first_name": "ALICIA",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-30",
        "last_updated": "2023-12-28",
        "certification_date": "2023-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "VA",
            "license": "0810004365",
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "MD",
            "license": "05106",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MD",
            "license": "05106",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810004365",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALICIA",
            "last_name": "FIELDS",
            "credential": "PH.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Hannah L Cangco
• Mia Cann
• Cannakush Consulting Office LLC
• Cannakush Consulting Office LLC (KeyeWellness Treatment)
• Tamira Cannie, FNP
• Alison L Cannon, CRNP
• Julianne Katherine Cannon, PT, DPT
• Michael David Cannon, M.D.
• Molly Cannon
• Shirina Cannon

• Clinical Neuropsychologist in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Clinical Neuropsychologist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.