Provider Demographics
NPI:1619089703
Name:TAKIFF, NATALIE JAN (MS)
Entity Type:Individual
Prefix:MS
First Name:NATALIE
Middle Name:JAN
Last Name:TAKIFF
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19214 BLACK MANGROVE CT
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498-4835
Mailing Address - Country:US
Mailing Address - Phone:561-488-1919
Mailing Address - Fax:561-488-1819
Practice Address - Street 1:9325 GLADES RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-3988
Practice Address - Country:US
Practice Address - Phone:561-488-1919
Practice Address - Fax:561-488-1819
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT0001539101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health