Provider Demographics
NPI:1437652203
Name:CHRISTINA M. CAVALIERE, LISW, LLC
Entity Type:Organization
Organization Name:CHRISTINA M. CAVALIERE, LISW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:CAVALIERE
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:419-320-7944
Mailing Address - Street 1:10649 BROWN RD
Mailing Address - Street 2:
Mailing Address - City:CURTICE
Mailing Address - State:OH
Mailing Address - Zip Code:43412-9416
Mailing Address - Country:US
Mailing Address - Phone:419-329-7944
Mailing Address - Fax:
Practice Address - Street 1:860 ANSONIA ST STE 13A
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3177
Practice Address - Country:US
Practice Address - Phone:419-320-7944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.12009871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1801234448Medicaid