Provider Demographics
NPI:1740536838
Name:CANNON, MEGAN (PHD)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:
Last Name:CANNON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 BATH PIKE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-2466
Mailing Address - Country:US
Mailing Address - Phone:610-867-7770
Mailing Address - Fax:
Practice Address - Street 1:3400 BATH PIKE
Practice Address - Street 2:SUITE 302
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-2466
Practice Address - Country:US
Practice Address - Phone:610-867-7770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-26
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017891103TE1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports