Basic Information
| Provider Information | |||||||||
| NPI: | 1003010455 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAVANAUGH TOFT | ||||||||
| FirstName: | CAROLYN | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 202 E EARLL DR | ||||||||
| Address2: | SUITE 420 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850122634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4803296791 | ||||||||
| FaxNumber: | 6022790297 | ||||||||
| Practice Location | |||||||||
| Address1: | 202 E EARLL DR | ||||||||
| Address2: | SUITE 420 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850122634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4803296791 | ||||||||
| FaxNumber: | 6022790297 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2007 | ||||||||
| LastUpdateDate: | 03/19/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 3268 | AZ | N | Behavioral Health & Social Service Providers | Psychologist | 103TC0700X | 3268 | AZ | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.