Provider Demographics
NPI:1053545939
Name:CAVARETTA, CHARLES J II (CPRP)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:J
Last Name:CAVARETTA
Suffix:II
Gender:M
Credentials:CPRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:254 FRANKLIN ST
Mailing Address - Street 2:LAKE SHORE BEHAVIORAL HEALTH, INC;
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-1932
Mailing Address - Country:US
Mailing Address - Phone:716-842-0440
Mailing Address - Fax:716-842-4069
Practice Address - Street 1:254 FRANKLIN ST
Practice Address - Street 2:FRANKLIN RECOVERY PROS
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-1932
Practice Address - Country:US
Practice Address - Phone:716-852-1117
Practice Address - Fax:716-852-1110
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-07
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor