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General NPI Number Information
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NPI Number | 1558524660
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Entity Type | Organization
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Legal Business Name | TIFFANY M KAVANAUGH LCSW LLC
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Dates
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Enumeration Date | 07/08/2008
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Last Update Date | 05/09/2023
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Provider Practice Location Address
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Address Line | 3801 UNION DR SUITE 206
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City | LINCOLN
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State | NE
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Zip | 68516-6652
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Country | US
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Telephone | 402-489-2218
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Fax |
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Provider Business Mailing Address
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Address Line | 3701 UNION DR STE 100
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City | LINCOLN
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State | NE
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Zip | 68516-6629
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Country | US
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Telephone | 402-875-9270
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Fax | 402-875-9272
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Authorized Official
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Title or Position | SOLE MEMBER/MANAGER
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Name | TIFFANY M KAVANAUGH
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Credential | LCSW
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Telephone | 25-404-9534
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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 | 424
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License Number State | NE
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