Provider Demographics
NPI:1962469429
Name:CAVENEE, GERALD (PHD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:
Last Name:CAVENEE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9340 NE 76TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-3721
Mailing Address - Country:US
Mailing Address - Phone:360-253-4912
Mailing Address - Fax:360-253-5170
Practice Address - Street 1:430 LILLY RD NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5132
Practice Address - Country:US
Practice Address - Phone:360-491-9700
Practice Address - Fax:360-923-5330
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00001644103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical