Provider Demographics
NPI:1689139016
Name:ROXANNE CAVATAIO, LCSW, PLLC
Entity type:Organization
Organization Name:ROXANNE CAVATAIO, LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAVATAIO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:228-216-7353
Mailing Address - Street 1:PO BOX 4456
Mailing Address - Street 2:
Mailing Address - City:BAY ST LOUIS
Mailing Address - State:MS
Mailing Address - Zip Code:39521-4456
Mailing Address - Country:US
Mailing Address - Phone:228-861-5260
Mailing Address - Fax:
Practice Address - Street 1:1403 43RD AVE
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2545
Practice Address - Country:US
Practice Address - Phone:228-861-5260
Practice Address - Fax:228-241-0326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty