Provider Demographics
NPI:1770837411
Name:CAVANAGH, ALYSS LIAN (MA, LMHC)
Entity type:Individual
Prefix:MRS
First Name:ALYSS
Middle Name:LIAN
Last Name:CAVANAGH
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:MISS
Other - First Name:ALYSS
Other - Middle Name:
Other - Last Name:LIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:109 OAK ST
Mailing Address - Street 2:SUITE G 10
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02464-1492
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:109 OAK ST
Practice Address - Street 2:SUITE G 10
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02464-1492
Practice Address - Country:US
Practice Address - Phone:617-467-4523
Practice Address - Fax:617-916-5081
Is Sole Proprietor?:No
Enumeration Date:2012-11-02
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005310101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health