MEDICARE: DR. GRAHAM GEORGE KAVANAGH PH.D.

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	103T00000X	Psychologist	008331	NY

General Provider Information

NPI Number	:	1194772434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GRAHAM GEORGE KAVANAGH PH.D.

Provider Business Mailing Address
First Line	:	211 W 56TH ST
Second Line	:	35A
City	:	NEW YORK
State	:	NY
Zip	:	10019-4312
Country	:	US
Telephone Number	:	212-247-1831
Fax Number	:	212-247-0255

Provider Business Practice Location Address
First Line	:	211 W 56TH ST
Second Line	:	35A
City	:	NEW YORK
State	:	NY
Zip	:	10019-4312
Country	:	US
Telephone Number	:	212-247-1831
Fax Number	:	212-247-0255

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

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	02/17/2014

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Directions to “ DR. GRAHAM GEORGE KAVANAGH PH.D.” Practice Location

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