MEDICARE: DR. NICOLE ANN CAVENAGH PHD

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	103TB0200X	Cognitive & Behavioral Psychologist	P40584	NV
2	103G00000X	Clinical Neuropsychologist	PY0584	NV

General Provider Information

NPI Number	:	1326373960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLE ANN CAVENAGH PHD

Provider Business Mailing Address
First Line	:	3211 E WARM SPRINGS RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3157
Country	:	US
Telephone Number	:	702-912-5848
Fax Number	:	702-912-0442

Provider Business Practice Location Address
First Line	:	3211 E WARM SPRINGS RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3157
Country	:	US
Telephone Number	:	702-912-5848
Fax Number	:	702-912-0442

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

Provider Enumeration Date	:	10/15/2009
Last Update Date	:	11/23/2021

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