Individual
MRS. KELLY KAVANAUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S. ED.
Contact information
Practice address
621 7TH AVE, EAST NORTHPORT, NY 11731-2329
(631) 754-7778
Mailing address
621 7TH AVE, EAST NORTHPORT, NY 11731-2329
(631) 754-7778
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
06/06/2012
Last updated
06/06/2012
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