Provider Demographics
NPI:1003285495
Name:CRESSOTTI, MEGHAN CAVANAUGH
Entity Type:Individual
Prefix:MRS
First Name:MEGHAN
Middle Name:CAVANAUGH
Last Name:CRESSOTTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:ELIZABETH
Other - Last Name:CAVANAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3017 ALBACORE CIR
Mailing Address - Street 2:G-19
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98315-9779
Mailing Address - Country:US
Mailing Address - Phone:860-916-3490
Mailing Address - Fax:
Practice Address - Street 1:231 SE BARRINGTON DR
Practice Address - Street 2:SUITE 203
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-3200
Practice Address - Country:US
Practice Address - Phone:360-240-0022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT198305983103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst