Provider Demographics
NPI:1396415063
Name:CAVAGNA, MARY I
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:I
Last Name:CAVAGNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 W CHEMUNG ST # 103
Mailing Address - Street 2:
Mailing Address - City:PAINTED POST
Mailing Address - State:NY
Mailing Address - Zip Code:14870-1300
Mailing Address - Country:US
Mailing Address - Phone:607-973-2262
Mailing Address - Fax:607-973-2347
Practice Address - Street 1:126 W CHEMUNG ST # 103
Practice Address - Street 2:
Practice Address - City:PAINTED POST
Practice Address - State:NY
Practice Address - Zip Code:14870-1300
Practice Address - Country:US
Practice Address - Phone:607-973-2262
Practice Address - Fax:607-973-2347
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator