Basic Information
| Provider Information | |||||||||
| NPI: | 1003285495 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRESSOTTI | ||||||||
| FirstName: | MEGHAN | ||||||||
| MiddleName: | CAVANAUGH | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CAVANAUGH | ||||||||
| OtherFirstName: | MEGHAN | ||||||||
| OtherMiddleName: | ELIZABETH | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3017 ALBACORE CIR | ||||||||
| Address2: | G-19 | ||||||||
| City: | SILVERDALE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983159779 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8609163490 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 231 SE BARRINGTON DR | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | OAK HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982773200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3602400022 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2015 | ||||||||
| LastUpdateDate: | 09/24/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 198305983 | CT | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.