Provider Demographics
NPI:1194388579
Name:CAVIC, RUYN N (PHD)
Entity Type:Individual
Prefix:DR
First Name:RUYN
Middle Name:N
Last Name:CAVIC
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 HUNTINGTON PL
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-2110
Mailing Address - Country:US
Mailing Address - Phone:315-796-9636
Mailing Address - Fax:
Practice Address - Street 1:807 NEWELL ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5313
Practice Address - Country:US
Practice Address - Phone:315-796-9636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-21
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009684101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health