Provider Demographics
NPI:1417054305
Name:TAKACS, MARTA (PSYCHOLOGIST MA)
Entity Type:Individual
Prefix:MS
First Name:MARTA
Middle Name:
Last Name:TAKACS
Suffix:
Gender:F
Credentials:PSYCHOLOGIST MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4859 DOVER CENTER RD #9
Mailing Address - Street 2:
Mailing Address - City:N OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070
Mailing Address - Country:US
Mailing Address - Phone:440-779-8880
Mailing Address - Fax:440-779-9559
Practice Address - Street 1:4859 DOVER CENTER RD #9
Practice Address - Street 2:
Practice Address - City:N OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070
Practice Address - Country:US
Practice Address - Phone:440-779-8880
Practice Address - Fax:440-779-9559
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2078103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0356501Medicaid
TA0686031Medicare ID - Type Unspecified