Provider Demographics
NPI:1154599769
Name:CADWALLADER, JOHN (PSYD, LMHC, HSPP)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:CADWALLADER
Suffix:
Gender:M
Credentials:PSYD, LMHC, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17333
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46217-0333
Mailing Address - Country:US
Mailing Address - Phone:317-780-1610
Mailing Address - Fax:317-780-1698
Practice Address - Street 1:6249 S EAST ST STE I
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-2089
Practice Address - Country:US
Practice Address - Phone:317-780-1610
Practice Address - Fax:317-780-5755
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor