Provider Demographics
NPI:1710548367
Name:CAVANAGH, DAIVD ALLEN
Entity Type:Individual
Prefix:
First Name:DAIVD
Middle Name:ALLEN
Last Name:CAVANAGH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 LOWER ENGLISH SETTLEMENT RD
Mailing Address - Street 2:
Mailing Address - City:UNDERHILL
Mailing Address - State:VT
Mailing Address - Zip Code:05489-9348
Mailing Address - Country:US
Mailing Address - Phone:802-488-0076
Mailing Address - Fax:
Practice Address - Street 1:99 LOWER ENGLISH SETTLEMENT RD
Practice Address - Street 2:
Practice Address - City:UNDERHILL
Practice Address - State:VT
Practice Address - Zip Code:05489-9348
Practice Address - Country:US
Practice Address - Phone:802-488-0076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0057588101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty