Provider Demographics
NPI:1003963844
Name:WOHL, MARIANNE KATZ (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARIANNE
Middle Name:KATZ
Last Name:WOHL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 WEST MARKET STREET
Mailing Address - Street 2:SUITE NUMBER 11
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3318
Mailing Address - Country:US
Mailing Address - Phone:330-873-1151
Mailing Address - Fax:330-873-1151
Practice Address - Street 1:3250 WEST MARKET STREET
Practice Address - Street 2:SUITE NUMBER 11
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3318
Practice Address - Country:US
Practice Address - Phone:330-873-1151
Practice Address - Fax:330-873-1151
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3112103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0707140Medicaid
OHCP20641Medicare ID - Type Unspecified