Healthcare Provider Details

I. General information

NPI: 1861008500
Provider Name (Legal Business Name): LAUREN GAIL CAVANAUGH LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 09/20/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 BRICK KILN RD
TEATICKET MA
02536-5651
US

IV. Provider business mailing address

2 ELLIOT LN
FAIRHAVEN MA
02719-3032
US

V. Phone/Fax

Practice location:
  • Phone: 508-388-7613
  • Fax:
Mailing address:
  • Phone: 508-965-5828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number125541
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: