Provider Demographics
NPI:1326164591
Name:CAVENAUGH, SUSAN DIANE (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:DIANE
Last Name:CAVENAUGH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:427 PRESTON CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-8983
Mailing Address - Country:US
Mailing Address - Phone:678-548-8813
Mailing Address - Fax:
Practice Address - Street 1:1826 VETERAN'S BOULEVARD
Practice Address - Street 2:CARL VINSON VA MEDICAL CENTER
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021
Practice Address - Country:US
Practice Address - Phone:478-272-1210
Practice Address - Fax:478-277-2717
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0033321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical