Provider Demographics
NPI:1154668325
Name:TAKETA, STEVEN RONALD (PSYD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:RONALD
Last Name:TAKETA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4613
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-8613
Mailing Address - Country:US
Mailing Address - Phone:808-782-3551
Mailing Address - Fax:
Practice Address - Street 1:1113 KAPAHULU AVE
Practice Address - Street 2:SUIT C
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-5866
Practice Address - Country:US
Practice Address - Phone:808-782-3551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-1333103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic