Healthcare Provider Details

I. General information

NPI: 1255477477
Provider Name (Legal Business Name): DEBORAH J CAVANAUGH LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 11/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WASHINGTON ST
TAUNTON MA
02780-3960
US

IV. Provider business mailing address

2 CICERO DR
LAKEVILLE MA
02347-1681
US

V. Phone/Fax

Practice location:
  • Phone: 508-828-9218
  • Fax:
Mailing address:
  • Phone: 508-947-7157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number7059
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7059
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: