Provider Demographics
NPI:1497588917
Name:CAVENEY, SUSAN JAN (MS)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:JAN
Last Name:CAVENEY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:584 CAESAR DR
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-6335
Mailing Address - Country:US
Mailing Address - Phone:317-439-7615
Mailing Address - Fax:
Practice Address - Street 1:7203 E US HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7967
Practice Address - Country:US
Practice Address - Phone:317-544-6700
Practice Address - Fax:317-544-6001
Is Sole Proprietor?:No
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1269393103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool