Provider Demographics
NPI:1780399675
Name:KAVANAUGH, KATHERINE (PHD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:
Last Name:KAVANAUGH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13650 E COLFAX AVE APT 1217
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-6979
Mailing Address - Country:US
Mailing Address - Phone:817-312-7633
Mailing Address - Fax:
Practice Address - Street 1:4100 E MISSISSIPPI AVE STE 1300
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-3057
Practice Address - Country:US
Practice Address - Phone:817-312-7633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0006042103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist