Provider Demographics
NPI:1437414521
Name:CAVANAUGH, VALERIE ANN (MA)
Entity Type:Individual
Prefix:MS
First Name:VALERIE
Middle Name:ANN
Last Name:CAVANAUGH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:VALERIE
Other - Middle Name:ANN
Other - Last Name:CAVANAUGH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:445 EAST 86TH STREET #13E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028
Mailing Address - Country:US
Mailing Address - Phone:212-996-5835
Mailing Address - Fax:
Practice Address - Street 1:445 EAST 86TH STREET #13E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028
Practice Address - Country:US
Practice Address - Phone:212-996-5835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY662465951174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist