Provider Demographics
NPI:1265523484
Name:CANNICI, JAMES (PHD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:CANNICI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:909 W MAGNOLIA AVE
Mailing Address - Street 2:SUITE 20
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4571
Mailing Address - Country:US
Mailing Address - Phone:817-925-6594
Mailing Address - Fax:888-802-5455
Practice Address - Street 1:909 W MAGNOLIA AVE
Practice Address - Street 2:SUITE 20
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4571
Practice Address - Country:US
Practice Address - Phone:817-925-6594
Practice Address - Fax:888-802-5455
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX22101103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist