Provider Demographics
NPI:1518238385
Name:CAVANAUGH, KATHLEEN MARIE (MSW CADC M)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:MARIE
Last Name:CAVANAUGH
Suffix:
Gender:F
Credentials:MSW CADC M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2412 WOODBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329-2472
Mailing Address - Country:US
Mailing Address - Phone:248-259-1101
Mailing Address - Fax:248-461-6020
Practice Address - Street 1:3650 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-4290
Practice Address - Country:US
Practice Address - Phone:248-674-4630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)