Healthcare Provider Details

I. General information

NPI: 1649940834
Provider Name (Legal Business Name): JOSEPH RYAN CAGGIANO M.S., MSW,LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2021
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 W MAIN ST STE A
TAVARES FL
32778-3131
US

IV. Provider business mailing address

201 WINDEMERE AVE
EUSTIS FL
32726-5536
US

V. Phone/Fax

Practice location:
  • Phone: 321-800-8439
  • Fax:
Mailing address:
  • Phone: 352-409-7328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW22612
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: