Provider Demographics
NPI:1821416967
Name:FADER, JON (LCAC, LCSW)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:FADER
Suffix:
Gender:M
Credentials:LCAC, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-2939
Mailing Address - Country:US
Mailing Address - Phone:407-347-4536
Mailing Address - Fax:
Practice Address - Street 1:1507 SPRING ST
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-2939
Practice Address - Country:US
Practice Address - Phone:407-347-4536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-05
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34010187A1041C0700X
IN87000979A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical