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NPI Code Detail

MEDICARE: MRS. KANDICE KLOREN KAVANAGH PSYCHIATRIC NP

MEDICARE: MRS. KANDICE KLOREN KAVANAGH PSYCHIATRIC NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner406724NY

General Provider Information

NPI Number : 1013249994
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KANDICE KLOREN KAVANAGH PSYCHIATRIC NP
Provider Business Mailing Address
First Line : 205 HUDSON ST FL 9
Second Line :
City : NEW YORK
State : NY
Zip : 10013-1810
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 205 HUDSON ST FL 9
Second Line :
City : NEW YORK
State : NY
Zip : 10013-1810
Country : US
Telephone Number : 914-517-0058
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2010
Last Update Date : 09/09/2025

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