Provider Demographics
NPI:1942518816
Name:KAVANAGH, MEGAN MICHELLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:MICHELLE
Last Name:KAVANAGH
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 1:68 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:MA
Mailing Address - Zip Code:02152-2558
Mailing Address - Country:US
Mailing Address - Phone:609-827-5611
Mailing Address - Fax:
Practice Address - Street 1:210 HUMPHREY ST
Practice Address - Street 2:SUITE 111
Practice Address - City:MARBLEHEAD
Practice Address - State:MA
Practice Address - Zip Code:01945-1665
Practice Address - Country:US
Practice Address - Phone:781-797-0234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health