Provider Demographics
NPI:1861008500
Name:CAVANAUGH, LAUREN GAIL (LICSW)
Entity Type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:GAIL
Last Name:CAVANAUGH
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 1:2 ELLIOT LN
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-3032
Mailing Address - Country:US
Mailing Address - Phone:508-965-5828
Mailing Address - Fax:
Practice Address - Street 1:279 BRICK KILN RD
Practice Address - Street 2:
Practice Address - City:TEATICKET
Practice Address - State:MA
Practice Address - Zip Code:02536-5651
Practice Address - Country:US
Practice Address - Phone:508-388-7613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-18
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1255411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical