Provider Demographics
NPI:1649760844
Name:KAVANAUGH, MARIA ANGELA (LICSW)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ANGELA
Last Name:KAVANAUGH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NORTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02357-4562
Mailing Address - Country:US
Mailing Address - Phone:508-565-1331
Mailing Address - Fax:508-565-1691
Practice Address - Street 1:320 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02357-4562
Practice Address - Country:US
Practice Address - Phone:508-565-1331
Practice Address - Fax:508-565-1691
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1131811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical