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General NPI Number Information
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NPI Number | 1326164591
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Entity Type | Individual
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Provider Name | SUSAN DIANE CAVENAUGH LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 03/09/2009
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Provider Practice Location Address
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Address Line | 1826 VETERAN'S BOULEVARD CARL VINSON VA MEDICAL CENTER
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City | DUBLIN
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State | GA
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Zip | 31021
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Country | US
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Telephone | 478-272-1210
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Fax | 478-277-2717
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Provider Business Mailing Address
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Address Line | 427 PRESTON CREEK DR
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City | MCDONOUGH
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State | GA
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Zip | 30253-8983
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Country | US
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Telephone | 678-548-8813
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW003332
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License Number State | GA
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