Provider Demographics
NPI:1558729590
Name:CADEAU, SONDY
Entity Type:Individual
Prefix:
First Name:SONDY
Middle Name:
Last Name:CADEAU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 WOODIRON DR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-7494
Mailing Address - Country:US
Mailing Address - Phone:908-456-6317
Mailing Address - Fax:
Practice Address - Street 1:5971 PARKWAY NORTH BLVD STE C
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-8842
Practice Address - Country:US
Practice Address - Phone:404-388-3909
Practice Address - Fax:678-712-1945
Is Sole Proprietor?:No
Enumeration Date:2016-02-05
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC056696001041C0700X
GACSW0064771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4144007Medicaid
NJ4144007Medicaid
NJ31-4011Medicare PIN