Provider Demographics
NPI:1366471484
Name:CAVENAGH, DANIELLA (PHD)
Entity Type:Individual
Prefix:
First Name:DANIELLA
Middle Name:
Last Name:CAVENAGH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 144
Mailing Address - Street 2:
Mailing Address - City:FLOURTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19031-0144
Mailing Address - Country:US
Mailing Address - Phone:215-258-4191
Mailing Address - Fax:
Practice Address - Street 1:1265 DRUMMERS LN STE 120
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-1570
Practice Address - Country:US
Practice Address - Phone:215-258-4191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18504103TC0700X
MNLP4910103TC0700X
PAPS016868103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PL185040Medicare ID - Type Unspecified
P84656Medicare UPIN