Provider Demographics
NPI:1861416927
Name:WADE, JONATHAN RICHARD SR (LCSW)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:RICHARD
Last Name:WADE
Suffix:SR
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:JONATHAN
Other - Middle Name:RICHARD
Other - Last Name:WADE
Other - Suffix:SR
Other - Last Name Type:Other Name
Other - Credentials:CERTIFIED ADDICTION
Mailing Address - Street 1:908 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33755-4239
Mailing Address - Country:US
Mailing Address - Phone:727-398-6661
Mailing Address - Fax:727-398-9509
Practice Address - Street 1:10000 BAY PINES BLVD.
Practice Address - Street 2:DOM C-180
Practice Address - City:BAY PINES
Practice Address - State:FL
Practice Address - Zip Code:33744
Practice Address - Country:US
Practice Address - Phone:727-398-6661
Practice Address - Fax:727-398-9509
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW85691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical