Provider Demographics
NPI:1326373960
Name:CAVENAGH, NICOLE ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:ANN
Last Name:CAVENAGH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3211 E WARM SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-3157
Mailing Address - Country:US
Mailing Address - Phone:702-912-5848
Mailing Address - Fax:702-912-0442
Practice Address - Street 1:3211 E WARM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3157
Practice Address - Country:US
Practice Address - Phone:702-912-5848
Practice Address - Fax:702-912-0442
Is Sole Proprietor?:No
Enumeration Date:2009-10-15
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVP40584103TB0200X
NVPY0584103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral