Provider Demographics
NPI:1467609453
Name:MCGUCKIAN-CAVANAUGH, PATRICIA (MFT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:MCGUCKIAN-CAVANAUGH
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:THURBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3030 ASHBY AVE
Mailing Address - Street 2:SUITE 117
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2453
Mailing Address - Country:US
Mailing Address - Phone:510-287-8765
Mailing Address - Fax:
Practice Address - Street 1:3030 ASHBY AVE
Practice Address - Street 2:SUITE 117
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2453
Practice Address - Country:US
Practice Address - Phone:510-287-8765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT29882106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist