Active NPI
Bonnie L. Cannon, LICSW
- Clinical Social Worker
- Andover, MA
National Provider Identifier
1609354711
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LICSW119930
- Practice address
- 2 Dundee Park Dr Ste 301
Andover, MA 01810-3725 - Phone
- (978) 396-9866
- NPI assigned
- Jul 31, 2018
- Sex
- Female
- Sole proprietor
- Yes
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 | LICSW119930 | MA | Primary |
Addresses
Primary practice location
2 Dundee Park Dr Ste 301
Andover, MA 01810-3725
Mailing address
2 Dundee Park Dr Ste 301
Andover, MA 01810-3725
Phone (978) 396-9866
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Dec 11, 2024 through Dec 11, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LICSW119930 | MA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1532995200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1697932800000",
"number": "1609354711",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2 DUNDEE PARK DR STE 301",
"city": "ANDOVER",
"state": "MA",
"postal_code": "018103725",
"telephone_number": "978-396-9866"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2 DUNDEE PARK DR STE 301",
"city": "ANDOVER",
"state": "MA",
"postal_code": "018103725",
"telephone_number": "978-396-9866"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CANNON",
"first_name": "BONNIE",
"middle_name": "L.",
"credential": "LICSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-07-31",
"last_updated": "2023-10-22",
"certification_date": "2023-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "LICSW119930",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Andover, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.