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General NPI Number Information
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NPI Number | 1669109120
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Entity Type | Individual
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Provider Name | SOPHIA CACCAMO
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Gender | Female
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Dates
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Enumeration Date | 08/04/2022
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Last Update Date | 02/04/2026
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Provider Practice Location Address
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Address Line | 9100 BROMBACH ST
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City | HAMTRAMCK
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State | MI
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Zip | 48212-3473
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Country | US
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Telephone | 313-972-9031
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Fax |
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Provider Business Mailing Address
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Address Line | 1 FORD PL STE 3A
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City | DETROIT
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State | MI
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Zip | 48202-3450
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Country | US
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Telephone | 800-999-5829
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Fax | 313-876-1305
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 7401002599
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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