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General NPI Number Information
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NPI Number | 1053545939
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Entity Type | Individual
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Provider Name | CHARLES J. CAVARETTA II CPRP
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Gender | Male
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Dates
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Enumeration Date | 05/07/2009
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Last Update Date | 05/18/2009
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Provider Practice Location Address
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Address Line | 254 FRANKLIN ST FRANKLIN RECOVERY PROS
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City | BUFFALO
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State | NY
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Zip | 14202-1932
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Country | US
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Telephone | 716-852-1117
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Fax | 716-852-1110
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Provider Business Mailing Address
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Address Line | 254 FRANKLIN ST LAKE SHORE BEHAVIORAL HEALTH, INC;
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City | BUFFALO
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State | NY
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Zip | 14202-1932
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Country | US
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Telephone | 716-842-0440
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Fax | 716-842-4069
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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