Provider Demographics
NPI:1770019713
Name:CAVANAUGH, BRENNA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BRENNA
Middle Name:
Last Name:CAVANAUGH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE BOX 635
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-7787
Mailing Address - Fax:585-275-2352
Practice Address - Street 1:200 EAST RIVER RD.
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623
Practice Address - Country:US
Practice Address - Phone:585-275-2986
Practice Address - Fax:585-275-3366
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY21950103TC0700X
NY021950103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical