Provider Demographics
NPI:1558481374
Name:CAVANAGH, GAIL EDITH (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:EDITH
Last Name:CAVANAGH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-1718
Mailing Address - Country:US
Mailing Address - Phone:631-331-4714
Mailing Address - Fax:631-331-8845
Practice Address - Street 1:637 HIGH ST
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-1718
Practice Address - Country:US
Practice Address - Phone:631-331-4714
Practice Address - Fax:631-331-8845
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO36488-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical