Provider Demographics
NPI:1023509825
Name:CANNON, KEVIN T (PHD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:T
Last Name:CANNON
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 1:5 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NH
Mailing Address - Zip Code:03051-4781
Mailing Address - Country:US
Mailing Address - Phone:603-438-3523
Mailing Address - Fax:
Practice Address - Street 1:3 DUNDEE PARK DR STE 203
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-3723
Practice Address - Country:US
Practice Address - Phone:978-655-2252
Practice Address - Fax:978-296-5594
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11371103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist