Provider Demographics
NPI:1124478474
Name:KALI CAVANAUGH LCSW LLC
Entity type:Organization
Organization Name:KALI CAVANAUGH LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KALI
Authorized Official - Middle Name:
Authorized Official - Last Name:CAVANAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-377-3921
Mailing Address - Street 1:475 WOODLAND ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06073-3524
Mailing Address - Country:US
Mailing Address - Phone:860-377-3921
Mailing Address - Fax:
Practice Address - Street 1:218 RIVER RD
Practice Address - Street 2:
Practice Address - City:UNIONVILLE
Practice Address - State:CT
Practice Address - Zip Code:06085-1098
Practice Address - Country:US
Practice Address - Phone:860-377-3921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-17
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009198251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health