Provider Demographics
NPI:1316245459
Name:CAVANAGH, PEGGY A (MSW)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:A
Last Name:CAVANAGH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 WOODLEA DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-1756
Mailing Address - Country:US
Mailing Address - Phone:734-657-7676
Mailing Address - Fax:
Practice Address - Street 1:214 S MAIN ST STE 204
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2122
Practice Address - Country:US
Practice Address - Phone:734-657-7676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-13
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010928571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical