Provider Demographics
NPI:1336266352
Name:KANNER, ALLEN DAVID (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:DAVID
Last Name:KANNER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 SOLANO AVE
Mailing Address - Street 2:UNIT A
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-1853
Mailing Address - Country:US
Mailing Address - Phone:510-558-7210
Mailing Address - Fax:
Practice Address - Street 1:1350 SOLANO AVE
Practice Address - Street 2:UNIT A
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-1853
Practice Address - Country:US
Practice Address - Phone:510-558-7210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 9273103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical