MEDICARE: DR. JOAN LEI KAVANAUGH D.MIN.

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
1	101YM0800X	Mental Health Counselor	002917-1	NY

General Provider Information

NPI Number	:	1184841355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOAN LEI KAVANAUGH D.MIN.

Provider Business Mailing Address
First Line	:	404 RIVERSIDE DR
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-1861
Country	:	US
Telephone Number	:	212-663-7458
Fax Number	:

Provider Business Practice Location Address
First Line	:	404 RIVERSIDE DR
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-1861
Country	:	US
Telephone Number	:	212-663-7458
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	07/08/2007

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