Provider Demographics
NPI:1235289372
Name:MCGAVIN, KATHLEEN MARIE (LISW)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:MARIE
Last Name:MCGAVIN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34305 SOLON RD
Mailing Address - Street 2:SUITE 52
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-2666
Mailing Address - Country:US
Mailing Address - Phone:440-349-3038
Mailing Address - Fax:440-349-3081
Practice Address - Street 1:34305 SOLON RD
Practice Address - Street 2:SUITE 52
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-2666
Practice Address - Country:US
Practice Address - Phone:440-349-3038
Practice Address - Fax:440-349-3081
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00075091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH242302000OtherMAGELLAN BEHAVIORAL HEALT
OHSW35511Medicare PIN