Provider Demographics
NPI:1598980161
Name:CAVALCONTE, CHARLES C (MDIV)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:C
Last Name:CAVALCONTE
Suffix:
Gender:M
Credentials:MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:RI
Mailing Address - Zip Code:02809-2226
Mailing Address - Country:US
Mailing Address - Phone:508-674-5600
Mailing Address - Fax:580-235-5053
Practice Address - Street 1:88 CHURCH ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:RI
Practice Address - Zip Code:02809-2226
Practice Address - Country:US
Practice Address - Phone:508-674-5600
Practice Address - Fax:580-235-5053
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1313101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)