Provider Demographics
NPI:1215411632
Name:CAVANAUGH, HEIDI VEGA (LICSW)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:VEGA
Last Name:CAVANAUGH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 BRYANT ST APT 1
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-2330
Mailing Address - Country:US
Mailing Address - Phone:617-543-3792
Mailing Address - Fax:978-491-6573
Practice Address - Street 1:19 BRYANT ST APT 1
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2330
Practice Address - Country:US
Practice Address - Phone:617-543-3792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1189571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical