Provider Demographics
NPI:1437273133
Name:KAVANAGH, LAWRENCE P
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:P
Last Name:KAVANAGH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MARBLE FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:78654-5901
Mailing Address - Country:US
Mailing Address - Phone:830-693-5244
Mailing Address - Fax:
Practice Address - Street 1:411 CRESTVIEW DR
Practice Address - Street 2:
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654-5901
Practice Address - Country:US
Practice Address - Phone:830-693-5244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18355104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker