Healthcare Provider Details

I. General information

NPI: 1104766823
Provider Name (Legal Business Name): CASSIDY ROSE CAVANAH MA, AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 CAMINO ALTO STE 204
MILL VALLEY CA
94941-2935
US

IV. Provider business mailing address

81 CAZNEAU AVE
SAUSALITO CA
94965-1801
US

V. Phone/Fax

Practice location:
  • Phone: 808-429-6335
  • Fax:
Mailing address:
  • Phone: 808-429-6335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT160004
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: