Healthcare Provider Details

I. General information

NPI: 1194879171
Provider Name (Legal Business Name): WILLIAM R KAVANAGH LCSW, CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S MARION ST
OAK PARK IL
60302-2809
US

IV. Provider business mailing address

120 S MARION ST
OAK PARK IL
60302-2809
US

V. Phone/Fax

Practice location:
  • Phone: 708-383-7500
  • Fax: 708-383-7780
Mailing address:
  • Phone: 708-383-7500
  • Fax: 708-383-7780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number14446
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: