Healthcare Provider Details

I. General information

NPI: 1821416967
Provider Name (Legal Business Name): JON FADER LCAC, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2014
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1507 SPRING ST
JEFFERSONVILLE IN
47130-2939
US

IV. Provider business mailing address

1507 SPRING ST
JEFFERSONVILLE IN
47130-2939
US

V. Phone/Fax

Practice location:
  • Phone: 407-347-4536
  • Fax:
Mailing address:
  • Phone: 407-347-4536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34010187A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number87000979A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: