Provider Demographics
NPI:1215108055
Name:CAVISTON, RENEE (PC)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:CAVISTON
Suffix:
Gender:F
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3023 MAY ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15234-2811
Mailing Address - Country:US
Mailing Address - Phone:412-668-0595
Mailing Address - Fax:
Practice Address - Street 1:5301 GROVE ROAD
Practice Address - Street 2:M123
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15236
Practice Address - Country:US
Practice Address - Phone:412-881-2255
Practice Address - Fax:412-881-5335
Is Sole Proprietor?:No
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004688101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional