Active NPI
Debra Kavanagh, PHD
- Psychologist
- Vero Beach, FL
National Provider Identifier
1891754206
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PY6392
- Practice address
- 4884 61St Cir
Vero Beach, FL 32967-6146 - Phone
- (772) 532-9728
- NPI assigned
- Mar 23, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PY6392 | FL | Primary |
Addresses
Primary practice location
4884 61St Cir
Vero Beach, FL 32967-6146
Mailing address
4884 61St Cir
Vero Beach, FL 32967-6146
Phone (772) 532-9728
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 54859 | Other | FL | BLUECROSS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20041201000925 | FL | Practitioner - Psychologist Billing Independently | 6608832605 | Practice locations: Port St Lucie, FL; Vero Beach, FL; Port Saint Lucie, FL; Jensen Beach, FL; Fort Pierce, FL |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1984
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
4884 61St Cir
Vero Beach, FL 32967-6146
Phone (772) 532-9728
4884 61St Circle
Vero Beach, FL 32967-6146
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143072000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1264982400000",
"number": "1891754206",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4884 61ST CIR",
"city": "VERO BEACH",
"state": "FL",
"postal_code": "329676146",
"telephone_number": "772-532-9728"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4884 61ST CIR",
"city": "VERO BEACH",
"state": "FL",
"postal_code": "329676146",
"telephone_number": "772-532-9728"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KAVANAGH",
"first_name": "DEBRA",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-03-23",
"last_updated": "2010-02-01",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "FL",
"license": "PY6392",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECROSS",
"identifier": "54859",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Vero Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.