Provider Demographics
NPI:1609008408
Name:CAVANAUGH, JANE (LCSW; ACSW)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:CAVANAUGH
Suffix:
Gender:F
Credentials:LCSW; ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 ESSEX ST
Mailing Address - Street 2:
Mailing Address - City:DEEP RIVER
Mailing Address - State:CT
Mailing Address - Zip Code:06417-1946
Mailing Address - Country:US
Mailing Address - Phone:860-526-9374
Mailing Address - Fax:
Practice Address - Street 1:149 DURHAM RD
Practice Address - Street 2:SUITE 31
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-2677
Practice Address - Country:US
Practice Address - Phone:203-245-1956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-13
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0009981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical