Provider Demographics
NPI:1982952305
Name:CAVANAUGH, SEAN DANIEL (LGSW)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:DANIEL
Last Name:CAVANAUGH
Suffix:
Gender:M
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 W LOMBARD ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1016
Mailing Address - Country:US
Mailing Address - Phone:301-910-2633
Mailing Address - Fax:
Practice Address - Street 1:1001 CROMWELL BRIDGE RD
Practice Address - Street 2:SUITE 212
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-3300
Practice Address - Country:US
Practice Address - Phone:410-337-5523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18034104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker