Individual
MRS. SUSANNAH E KAVANAUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LMHC, NCC
Contact information
Practice address
57 PHILIP ST, MEDFIELD, MA 02052-2704
(508) 566-4323
Mailing address
57 PHILIP ST, MEDFIELD, MA 02052-2704
(508) 566-4323
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
8720
MA
Other
Enumeration date
12/01/2011
Last updated
09/20/2016
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