Provider Demographics
NPI:1801437314
Name:CARDIN, JESSE RYAN (LCSW)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:RYAN
Last Name:CARDIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2186 JACKSON KELLER RD
Mailing Address - Street 2:PMB 3081
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213
Mailing Address - Country:US
Mailing Address - Phone:210-527-8755
Mailing Address - Fax:210-714-9757
Practice Address - Street 1:11-3784 2ND ST
Practice Address - Street 2:
Practice Address - City:VOLCANO
Practice Address - State:HI
Practice Address - Zip Code:96785
Practice Address - Country:US
Practice Address - Phone:210-527-8755
Practice Address - Fax:210-714-9757
Is Sole Proprietor?:No
Enumeration Date:2019-10-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA613902691041C0700X
HILCSW-50411041C0700X
TX642711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical