Provider Demographics
NPI:1114254935
Name:CANNING, ROBERT D (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:D
Last Name:CANNING
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 942883
Mailing Address - Street 2:CALIFORNIA DEPARTMENT OF CORRECTIONS & REHABILITATION
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:94283-0001
Mailing Address - Country:US
Mailing Address - Phone:916-322-4344
Mailing Address - Fax:916-445-0601
Practice Address - Street 1:501 J STREET, SUITE 530
Practice Address - Street 2:CALIFORNIA DEPARTMENT OF CORRECTIONS & REHABILITATION
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814
Practice Address - Country:US
Practice Address - Phone:916-322-4344
Practice Address - Fax:916-445-0601
Is Sole Proprietor?:No
Enumeration Date:2009-11-16
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 14961103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical