Provider Demographics
NPI:1811984081
Name:CAVANAUGH, LEAH MARIE (LISW)
Entity type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:MARIE
Last Name:CAVANAUGH
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7640 W BANCROFT ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43617-1604
Mailing Address - Country:US
Mailing Address - Phone:419-413-9147
Mailing Address - Fax:567-777-0197
Practice Address - Street 1:7640 W BANCROFT ST UNIT 2
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43617-1604
Practice Address - Country:US
Practice Address - Phone:419-413-9147
Practice Address - Fax:567-777-0197
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI10261104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker