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General NPI Number Information
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NPI Number | 1689139016
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Entity Type | Organization
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Legal Business Name | ROXANNE CAVATAIO, LCSW, PLLC
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Dates
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Enumeration Date | 02/11/2019
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Last Update Date | 02/11/2019
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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 | 39501-2545
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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 ST 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 |
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Authorized Official
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Title or Position | OWNER
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Name | ROXANNE CAVATAIO
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Credential | LCSW
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Telephone | 228-216-7353
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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 |
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License Number State |
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