Provider Demographics
NPI:1609269323
Name:CAVANAUGH, KYLA ANDREA
Entity Type:Individual
Prefix:MS
First Name:KYLA
Middle Name:ANDREA
Last Name:CAVANAUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 HIDDEN SPRING LN
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-2328
Mailing Address - Country:US
Mailing Address - Phone:215-694-2042
Mailing Address - Fax:
Practice Address - Street 1:308 CHAMOUNIX RD
Practice Address - Street 2:
Practice Address - City:ST DAVIDS
Practice Address - State:PA
Practice Address - Zip Code:19087-3612
Practice Address - Country:US
Practice Address - Phone:215-694-2042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA29800787103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst