Provider Demographics
NPI:1659521870
Name:SZALACH-CAVANAUGH, KRISTEN N (BA, LMT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:N
Last Name:SZALACH-CAVANAUGH
Suffix:
Gender:F
Credentials:BA, LMT
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:N
Other - Last Name:SZALACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA, LMT
Mailing Address - Street 1:1384 UNION RD.
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224
Mailing Address - Country:US
Mailing Address - Phone:716-863-6822
Mailing Address - Fax:
Practice Address - Street 1:1384 UNION RD.
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224
Practice Address - Country:US
Practice Address - Phone:716-863-6822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-24
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NY27 027469172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY46-4291762OtherSOLE PROPRIETOR