Provider Demographics
NPI:1932114493
Name:KAVEN, MARY C (PHD)
Entity Type:Individual
Prefix:
First Name:MARY C
Middle Name:
Last Name:KAVEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:933 BRADBURY DR SE
Mailing Address - Street 2:SUITE 2222
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4374
Mailing Address - Country:US
Mailing Address - Phone:505-272-3120
Mailing Address - Fax:505-272-8060
Practice Address - Street 1:1001 YALE BLVD NE
Practice Address - Street 2:UNM CHILDREN'S PSYCHIATRIC CENTER
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-3825
Practice Address - Country:US
Practice Address - Phone:505-272-2890
Practice Address - Fax:505-272-1943
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM607103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist