Healthcare Provider Details

I. General information

NPI: 1497126940
Provider Name (Legal Business Name): DREW CAVANAUGH LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2015
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 N 111TH WAY
MESA AZ
85207-2208
US

IV. Provider business mailing address

1533 EUTERPE ST
NEW ORLEANS LA
70130-4450
US

V. Phone/Fax

Practice location:
  • Phone: 860-510-3550
  • Fax:
Mailing address:
  • Phone: 860-510-3550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21792
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number13585
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number13585
License Number StateLA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierLCSW-21792
Identifier TypeOTHER
Identifier StateAZ
Identifier IssuerARIZONA BOARD OF BEHAVIORAL HEALTH EXAMINERS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: