Provider Demographics
NPI:1003425646
Name:CAVISTON, KERRY HOWARD (LMHC)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:HOWARD
Last Name:CAVISTON
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 MIDDLE ST APT 2
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-3840
Mailing Address - Country:US
Mailing Address - Phone:197-887-0311
Mailing Address - Fax:
Practice Address - Street 1:32 MIDDLE ST APT 2
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-3840
Practice Address - Country:US
Practice Address - Phone:197-887-0311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11233101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health