Provider Demographics
NPI:1992025720
Name:AMY E CAVANAUGH PHD LLC
Entity Type:Organization
Organization Name:AMY E CAVANAUGH PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:E
Authorized Official - Last Name:CAVANAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-889-5830
Mailing Address - Street 1:PO BOX 80853
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70598-0853
Mailing Address - Country:US
Mailing Address - Phone:337-889-5830
Mailing Address - Fax:337-889-5834
Practice Address - Street 1:4540 AMBASSADOR CAFFERY PKWY STE C200
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6930
Practice Address - Country:US
Practice Address - Phone:337-889-5830
Practice Address - Fax:337-889-5834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-03
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty