Amy E Cavanaugh, PHD LLC
Individual provider Active NPI Clinical Psychologist · Lafayette, LA
NPI 1962554790 · NPPES record last updated Jan 31, 2024
Key facts
- NPI
- 1962554790
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 998 (LA)
- Practice address
- 3312 Kaliste Saloom Rd BLDG 1
Lafayette, LA 70508-7449 - Phone
- (337) 534-0727
- Fax
- (337) 534-0737
- NPI assigned
- Jan 18, 2007
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Clinical Psychologist
- Education
- University of Arkansas College of Medicine, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
3312 Kaliste Saloom Rd
BLDG 1
Lafayette, LA 70508-7449
Phone (337) 534-0727
3312 Kaliste Saloom Rd BLDG
Suite 1
Lafayette, LA 70508-7449
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20141117001054 | LA | Practitioner - Clinical Psychologist | 9436374980 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 998 | LA | MD | Clinical Child & Adolescent Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Acadiana Medical Psychological Services, LLC | Psychologist | Current | Accepting new patients |
| C. Scott Eckholdt, PH.D., LTD., a Professional Psychology Corporation | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cognitive & Behavioral Psychologist | 103TB0200X | 998 | LA | |
| Counseling Psychologist | 103TC1900X | 998 | LA | |
| Clinical Child & Adolescent Psychologist | 103TC2200X | 998 | LA | |
| Clinical Psychologist | 103TC0700X | 998 | LA | Yes |
| Family Psychologist | 103TF0000X | 998 | LA | |
| Group Psychotherapy Psychologist | 103TP2701X | 998 | LA | |
| Psychologist | 103T00000X | 998 | LA |
Addresses
Primary practice location
3312 Kaliste Saloom Rd BLDG 1
Lafayette, LA 70508-7449
Mailing address
3312 Kaliste Saloom Rd BLDG 1
Lafayette, LA 70508-7449
Phone (337) 534-0727
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2125541 | Medicaid | LA |
Other providers in Lafayette, LA
- Cath Lab Ambulatory Center Cardiology Specialist of Acadiana, LLC
- Catherine H Y a McDonald, M.D., a Professional Medical Corporation
- Leslie Jakeway Cathey
- Bailey Elizabeth Cauthen
- Jason George Cavalier
- Matthew Jude Cavanaugh
- Michael R. Cavanaugh
- Shavondali Harris Cawthorne
- CCFR, LLC
- CCP Medical Management LLC
All providers in Lafayette, LA · Clinical Psychologist in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 31, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.