Healthcare Provider Details

I. General information

NPI: 1336962125
Provider Name (Legal Business Name): JASON CUADRADO PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2024
Last Update Date: 11/01/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6950 W 34TH ST
INDIANAPOLIS IN
46214-1954
US

IV. Provider business mailing address

12994 FLEETWOOD DR N
CARMEL IN
46032-8528
US

V. Phone/Fax

Practice location:
  • Phone: 317-988-6189
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number10037701
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: