Provider Demographics
NPI:1255956348
Name:CAELAN SOMA PLLC
Entity type:Organization
Organization Name:CAELAN SOMA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAELAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:SOMA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LMSW
Authorized Official - Phone:586-899-5056
Mailing Address - Street 1:2310 LLOYD AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-3851
Mailing Address - Country:US
Mailing Address - Phone:586-899-5056
Mailing Address - Fax:
Practice Address - Street 1:3311 12 MILE RD
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-1394
Practice Address - Country:US
Practice Address - Phone:586-899-5056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health