MEDICARE: DAVID T. CAVANAUGH JR. LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	0904-000917	VA

General Provider Information

NPI Number	:	1609930098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID T. CAVANAUGH JR. LCSW

Provider Business Mailing Address
First Line	:	422 WOLFE ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-3728
Country	:	US
Telephone Number	:	703-836-6989
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 N WASHINGTON STREET
Second Line	:	SUITE 707
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-2530
Country	:	US
Telephone Number	:	703-399-4400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	09/05/2025

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