Provider Demographics
NPI:1336343722
Name:KAVANAGH, THOMAS EDWARD (PSYD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:EDWARD
Last Name:KAVANAGH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 NORTH FRANKLIN TURNPIKE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:HO HO KUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07423
Mailing Address - Country:US
Mailing Address - Phone:201-670-7449
Mailing Address - Fax:201-857-3810
Practice Address - Street 1:50 NORTH FRANKLIN TURNPIKE
Practice Address - Street 2:SUITE 204
Practice Address - City:HO HO KUS
Practice Address - State:NJ
Practice Address - Zip Code:07423
Practice Address - Country:US
Practice Address - Phone:201-670-7449
Practice Address - Fax:201-857-3810
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2045103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist