Individual
MRS. SHANA MARI CACIOPPO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY. D, LLP
Contact information
Practice address
25507 ECORSE RD, TAYLOR, MI 48180-1555
(313) 292-7640
(313) 292-9270
Mailing address
3401 19TH ST, WYANDOTTE, MI 48192-6029
(734) 320-9562
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301013864
MI
Other
Enumeration date
06/10/2008
Last updated
02/28/2012
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