MEDICARE: NICOLE ANN CAVENAGH, PHD, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103K00000X	Behavior Analyst
2	103TC0700X	Clinical Psychologist
3	103G00000X	Clinical Neuropsychologist

General Provider Information

NPI Number	:	1841969383
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NICOLE ANN CAVENAGH, PHD, LLC

Provider Business Mailing Address
First Line	:	3211 E WARM SPRINGS RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3157
Country	:	US
Telephone Number	:	702-912-5848
Fax Number	:

Provider Business Practice Location Address
First Line	:	3211 E WARM SPRINGS RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3157
Country	:	US
Telephone Number	:	702-912-5848
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PSYCHOLOGIST
Name	:	DR. NICOLE ANN CAVENAGH
Credential	:	PHD
Telephone Number	:	702-912-5848

Provider Enumeration Date	:	09/08/2021
Last Update Date	:	09/08/2021

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