Provider Demographics
NPI:1497238562
Name:CACAMO, JODY BARASH
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:BARASH
Last Name:CACAMO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-3432
Mailing Address - Country:US
Mailing Address - Phone:985-607-0290
Mailing Address - Fax:985-641-7887
Practice Address - Street 1:2130 1ST ST
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-3432
Practice Address - Country:US
Practice Address - Phone:985-607-0290
Practice Address - Fax:985-641-7887
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3168101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health