Active NPI
Jacqueline Cavanagh
- Mental Health Counselor
- Romney, WV
National Provider Identifier
1588251003
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 102
- Practice address
- 22347 Northwestern Pike
Romney, WV 26757-6343 - Phone
- (304) 822-6616
- NPI assigned
- Dec 30, 2020
- Last updated
- Sep 11, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 102 | WV | Primary |
Addresses
Primary practice location
22347 Northwestern Pike
Romney, WV 26757-6343
Mailing address
PO Box 97
Baker, WV 26801-0097
Phone (304) 897-5915
Other practice location 1
17978 Sr 55
Baker, WV 26801
Phone (304) 897-5915
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 102 | WV | MD | Advanced Practice Midwife |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1609286400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1694390400000",
"number": "1588251003",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 97",
"city": "BAKER",
"state": "WV",
"postal_code": "268010097",
"telephone_number": "304-897-5915"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22347 NORTHWESTERN PIKE",
"city": "ROMNEY",
"state": "WV",
"postal_code": "267576343",
"telephone_number": "304-822-6616"
}
],
"practiceLocations": [
{
"address_1": "17978 SR 55",
"address_purpose": "LOCATION",
"city": "Baker",
"state": "WV",
"postal_code": "26801",
"country_code": "US",
"telephone_number": "304-897-5915",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CAVANAGH",
"first_name": "JACQUELINE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-12-30",
"last_updated": "2023-09-11",
"certification_date": "2023-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WV",
"license": "102",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Romney, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.