Provider Demographics
NPI:1295276244
Name:KAVANAUGH, THOMAS KEVIN
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:KEVIN
Last Name:KAVANAUGH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MAPLE TER
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-6233
Mailing Address - Country:US
Mailing Address - Phone:978-304-7151
Mailing Address - Fax:
Practice Address - Street 1:2 MAPLE TER
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-6233
Practice Address - Country:US
Practice Address - Phone:978-304-7151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker