Provider Demographics
NPI:1730353251
Name:CAVITTA, DEZIRE (MA, NCC)
Entity type:Individual
Prefix:MS
First Name:DEZIRE
Middle Name:
Last Name:CAVITTA
Suffix:
Gender:X
Credentials:MA, NCC
Other - Prefix:
Other - First Name:D
Other - Middle Name:
Other - Last Name:CAVITTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, NCC
Mailing Address - Street 1:364 ARCHIE ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-6569
Mailing Address - Country:US
Mailing Address - Phone:541-727-2273
Mailing Address - Fax:
Practice Address - Street 1:364 ARCHIE ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-6569
Practice Address - Country:US
Practice Address - Phone:541-727-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 104100000X, 322D00000X
ORR9595101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1730353251OtherNPI
ORBX21058AMedicaid