Provider Demographics
NPI:1477113488
Name:CAVITT, HAROLD JOHN (BA CDC II)
Entity Type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:JOHN
Last Name:CAVITT
Suffix:
Gender:M
Credentials:BA CDC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2804 BERING ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-3820
Mailing Address - Country:US
Mailing Address - Phone:907-202-3306
Mailing Address - Fax:
Practice Address - Street 1:2804 BERING ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3820
Practice Address - Country:US
Practice Address - Phone:907-202-3306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2084101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1477113488Medicaid