Provider Demographics
NPI:1013635234
Name:CAVANAUGH, MATTHEW PETER (LCSW)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:PETER
Last Name:CAVANAUGH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 W SUPERIOR ST APT 1N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-5611
Mailing Address - Country:US
Mailing Address - Phone:708-691-6599
Mailing Address - Fax:
Practice Address - Street 1:899 SKOKIE BLVD STE 408
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4024
Practice Address - Country:US
Practice Address - Phone:847-559-3240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0247031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical