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General NPI Number Information
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NPI Number | 1255956348
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Entity Type | Organization
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Legal Business Name | CAELAN SOMA PLLC
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Dates
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Enumeration Date | 06/15/2020
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Last Update Date | 06/15/2020
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Provider Practice Location Address
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Address Line | 3311 12 MILE RD
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City | BERKLEY
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State | MI
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Zip | 48072-1394
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Country | US
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Telephone | 586-899-5056
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Fax |
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Provider Business Mailing Address
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Address Line | 2310 LLOYD AVE
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City | ROYAL OAK
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State | MI
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Zip | 48073-3851
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Country | US
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Telephone | 586-899-5056
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CAELAN K SOMA
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Credential | PSYD, LMSW
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Telephone | 586-899-5056
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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