Healthcare Provider Details

I. General information

NPI: 1225813819
Provider Name (Legal Business Name): BENJAMIN ADAM CAGE MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2023
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 RACQUETTE DR
FORT COLLINS CO
80524-4851
US

IV. Provider business mailing address

1205 BRIARWOOD RD
FORT COLLINS CO
80521-4204
US

V. Phone/Fax

Practice location:
  • Phone: 866-245-2381
  • Fax:
Mailing address:
  • Phone: 757-685-7225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWC.0000001567
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: