Provider Demographics
NPI:1073212866
Name:CANNON, CHERYL (LMSW)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:CANNON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4132 E JOPPA RD, STE 110-1427
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-2272
Mailing Address - Country:US
Mailing Address - Phone:443-946-0620
Mailing Address - Fax:
Practice Address - Street 1:4132 E JOPPA RD, STE 110-1427
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-2272
Practice Address - Country:US
Practice Address - Phone:443-946-0620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-01
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDG107831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical