Provider Demographics
NPI:1659300713
Name:CAVETT, ANGELA M (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:M
Last Name:CAVETT
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 1:102 W BEATON DR STE 103
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-2653
Mailing Address - Country:US
Mailing Address - Phone:701-356-1276
Mailing Address - Fax:701-356-4940
Practice Address - Street 1:102 W BEATON DR STE 103
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-2653
Practice Address - Country:US
Practice Address - Phone:701-356-1276
Practice Address - Fax:701-356-4940
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND372103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HP80577OtherHEALTHPARTNERS
ND28197OtherBCBS NORTH DAKOTA
ND12908Medicaid
MN208D7CAOtherBCBS MINNESOTA
MN187155100Medicaid
475441051343OtherPREFERREDONE
ND28197OtherBCBS NORTH DAKOTA
ND12908Medicaid