Healthcare Provider Details

I. General information

NPI: 1730353251
Provider Name (Legal Business Name): DEZIRE CAVITTA MA, NCC
Entity Type: Individual
Gender:
Sole Proprietor: Y

Provider Other Name: D CAVITTA MA, NCC

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

364 ARCHIE ST
EUGENE OR
97402-6569
US

IV. Provider business mailing address

364 ARCHIE ST
EUGENE OR
97402-6569
US

V. Phone/Fax

Practice location:
  • Phone: 541-727-2273
  • Fax:
Mailing address:
  • Phone: 541-727-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR9595
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1730353251
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerNPI
# 2
IdentifierBX21058A
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: