Provider Demographics
NPI:1114410438
Name:CAVANAUGH, PAMELA
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:CAVANAUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:CAVANAUGH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:163 MAPLE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062-9749
Mailing Address - Country:US
Mailing Address - Phone:413-230-6114
Mailing Address - Fax:
Practice Address - Street 1:108 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SUNDERLAND
Practice Address - State:MA
Practice Address - Zip Code:01375-9502
Practice Address - Country:US
Practice Address - Phone:413-665-8717
Practice Address - Fax:413-665-9383
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker