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General NPI Number Information
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NPI Number | 1285733329
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Entity Type | Individual
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Provider Name | ROXANNE CAVATAIO LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 12/05/2018
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Provider Practice Location Address
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Address Line | 1403 43RD AVE
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City | GULFPORT
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State | MS
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Zip | 39501
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Country | US
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Telephone | 228-861-5260
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Fax | 228-241-0326
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Provider Business Mailing Address
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Address Line | PO BOX 4456
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City | BAY SAINT LOUIS
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State | MS
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Zip | 39521-4456
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Country | US
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Telephone | 228-861-5260
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Fax | 228-241-0326
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C3900
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License Number State | MS
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