Provider Demographics
NPI:1609801802
Name:CANNON, MARGARET VICTORIA (LCSW)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:VICTORIA
Last Name:CANNON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62100 V 62 TRAIL
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401
Mailing Address - Country:US
Mailing Address - Phone:970-252-1577
Mailing Address - Fax:
Practice Address - Street 1:207 S 4TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-3644
Practice Address - Country:US
Practice Address - Phone:970-249-4757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical