Provider Demographics
NPI:1861163503
Name:REYES-CADY, ANDREW M (LSWAIC)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:M
Last Name:REYES-CADY
Suffix:
Gender:M
Credentials:LSWAIC
Other - Prefix:
Other - First Name:ANDREW
Other - Middle Name:M
Other - Last Name:REYES-CADY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 10509
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-0509
Mailing Address - Country:US
Mailing Address - Phone:360-320-6599
Mailing Address - Fax:
Practice Address - Street 1:9431 COPPERTOP LOOP NE UNIT 102D
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-3730
Practice Address - Country:US
Practice Address - Phone:360-320-6599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-22
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
WASC614293911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor