Healthcare Provider Details

I. General information

NPI: 1962554790
Provider Name (Legal Business Name): AMY E CAVANAUGH PHD LLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3312 KALISTE SALOOM RD BLDG 1
LAFAYETTE LA
70508-7449
US

IV. Provider business mailing address

3312 KALISTE SALOOM RD BLDG 1
LAFAYETTE LA
70508-7449
US

V. Phone/Fax

Practice location:
  • Phone: 337-534-0727
  • Fax: 337-534-0737
Mailing address:
  • Phone: 337-534-0727
  • Fax: 337-534-0737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number998
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number998
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number998
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number998
License Number StateLA
# 5
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number998
License Number StateLA
# 6
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number998
License Number StateLA
# 7
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number998
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: