Provider Demographics
NPI:1902022163
Name:CANNON, HEATHER MICHELLE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:MICHELLE
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 1:667 SHUNPIKE RD
Mailing Address - Street 2:
Mailing Address - City:GREEN VILLAGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07935-3021
Mailing Address - Country:US
Mailing Address - Phone:973-714-2453
Mailing Address - Fax:
Practice Address - Street 1:667 SHUNPIKE RD
Practice Address - Street 2:
Practice Address - City:GREEN VILLAGE
Practice Address - State:NJ
Practice Address - Zip Code:07935-3021
Practice Address - Country:US
Practice Address - Phone:973-714-2453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC057618001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical