MEDICARE: ANDREA L MCDONALD CAADE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1154505550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA L MCDONALD CAADE

Provider Business Mailing Address
First Line	:	1026 HAZEN DR
Second Line	:
City	:	SAN MARCOS
State	:	CA
Zip	:	92069-2009
Country	:	US
Telephone Number	:	760-518-1972
Fax Number	:

Provider Business Practice Location Address
First Line	:	243 S ESCONDIDO BLVD # 120
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92025-4116
Country	:	US
Telephone Number	:	760-741-0122
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2007
Last Update Date	:	12/20/2007

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