Healthcare Provider Details

I. General information

NPI: 1326793290
Provider Name (Legal Business Name): CARRIE L. CAVANAUGH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2022
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10526 ASPEN WOOD CT
MANASSAS VA
20110-2724
US

IV. Provider business mailing address

270 ROUTE 28
BRIDGEWATER NJ
08807-1919
US

V. Phone/Fax

Practice location:
  • Phone: 908-642-5112
  • Fax:
Mailing address:
  • Phone: 908-722-7022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202010414
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: