Healthcare Provider Details

I. General information

NPI: 1841969383
Provider Name (Legal Business Name): NICOLE ANN CAVENAGH, PHD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3211 E WARM SPRINGS RD
LAS VEGAS NV
89120-3157
US

IV. Provider business mailing address

3211 E WARM SPRINGS RD
LAS VEGAS NV
89120-3157
US

V. Phone/Fax

Practice location:
  • Phone: 702-912-5848
  • Fax:
Mailing address:
  • Phone: 702-912-5848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. NICOLE ANN CAVENAGH
Title or Position: LICENSED PSYCHOLOGIST
Credential: PHD
Phone: 702-912-5848