Provider Demographics
NPI:1720045578
Name:CANNON, HOPE (MA)
Entity Type:Individual
Prefix:MS
First Name:HOPE
Middle Name:
Last Name:CANNON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 413
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:VT
Mailing Address - Zip Code:05091-0413
Mailing Address - Country:US
Mailing Address - Phone:802-457-4081
Mailing Address - Fax:
Practice Address - Street 1:24 ELM ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WOODSTOCK
Practice Address - State:VT
Practice Address - Zip Code:05091-1000
Practice Address - Country:US
Practice Address - Phone:802-457-4081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT141103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT06806149OtherVT BLUE CROSS BLUE SHIELD
VTCA1002668Medicaid
VTCA1002668Medicaid