Provider Demographics
NPI:1750622148
Name:KAVANAGH, DORIAN JANE (LCSW)
Entity type:Individual
Prefix:
First Name:DORIAN
Middle Name:JANE
Last Name:KAVANAGH
Suffix:
Gender:F
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:PO BOX 186
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-0186
Mailing Address - Country:US
Mailing Address - Phone:917-923-5497
Mailing Address - Fax:
Practice Address - Street 1:342 GRAND AVE FL 2
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4355
Practice Address - Country:US
Practice Address - Phone:973-327-3445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-08
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054979001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical