Provider Demographics
NPI:1316076011
Name:MCCANN, THOMAS W (MS,EDD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:W
Last Name:MCCANN
Suffix:
Gender:M
Credentials:MS,EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7315 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-2126
Mailing Address - Country:US
Mailing Address - Phone:859-282-0119
Mailing Address - Fax:859-282-8018
Practice Address - Street 1:7315 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-2126
Practice Address - Country:US
Practice Address - Phone:859-282-0119
Practice Address - Fax:859-282-8018
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY14103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical