Provider Demographics
NPI:1518085414
Name:KAVANAGH, BARBARA M (RN/MSW)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:M
Last Name:KAVANAGH
Suffix:
Gender:F
Credentials:RN/MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3459 SEMINOLE LANE
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32448
Mailing Address - Country:US
Mailing Address - Phone:850-510-5145
Mailing Address - Fax:850-656-3802
Practice Address - Street 1:3459 SEMINOLE LANE
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32448
Practice Address - Country:US
Practice Address - Phone:850-510-5145
Practice Address - Fax:850-656-3802
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW4616101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)