Provider Demographics
NPI:1699482240
Name:CANNON, EVE J (LPC, LPAT, ATR-BC)
Entity type:Individual
Prefix:
First Name:EVE
Middle Name:J
Last Name:CANNON
Suffix:
Gender:F
Credentials:LPC, LPAT, ATR-BC
Other - Prefix:
Other - First Name:EVE
Other - Middle Name:
Other - Last Name:CANNON D'ONOFRIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8513 GLEN CAMPBELL RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-1212
Mailing Address - Country:US
Mailing Address - Phone:732-713-5585
Mailing Address - Fax:
Practice Address - Street 1:8513 GLEN CAMPBELL RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-1212
Practice Address - Country:US
Practice Address - Phone:732-713-5585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012268101YM0800X, 101YP2500X
NJ221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist