Healthcare Provider Details

I. General information

NPI: 1154998912
Provider Name (Legal Business Name): CADE RYAN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 09/13/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4651 SALISBURY RD STE 400
JACKSONVILLE FL
32256-6187
US

IV. Provider business mailing address

1120 NW 14TH ST STE 1311
MIAMI FL
33136-2107
US

V. Phone/Fax

Practice location:
  • Phone: 646-941-7645
  • Fax: 929-596-7897
Mailing address:
  • Phone: 847-970-1221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW27218
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: