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 1:205 HUDSON ST FL 9
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-1810
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:205 HUDSON ST FL 9
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-1810
Practice Address - Country:US
Practice Address - Phone:914-517-0058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY406724363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY294560OtherLICENSED PRACTICAL NURSE