Provider Demographics
NPI:1013249994
Name:KAVANAGH, KANDICE KLOREN (PSYCHIATRIC NP)
Entity type:Individual
Prefix:MRS
First Name:KANDICE
Middle Name:KLOREN
Last Name:KAVANAGH
Suffix:
Gender:F
Credentials:PSYCHIATRIC NP
Other - Prefix:MS
Other - First Name:KANDICE
Other - Middle Name:KLOREN
Other - Last Name:MANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 FILLMORE DR
Mailing Address - Street 2:
Mailing Address - City:STONY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10980-3705
Mailing Address - Country:US
Mailing Address - Phone:845-270-7895
Mailing Address - Fax:
Practice Address - Street 1:20 OLD TURNPIKE RD
Practice Address - Street 2:STE 105
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-2532
Practice Address - Country:US
Practice Address - Phone:845-624-0260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY294560164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY294560OtherLICENSED PRACTICAL NURSE