| Doctor Name: | MR. FREDERICK MARK SACKS |
| NPI Number: | 1205844263 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHD |
| License Number: | 3768 |
| Business Practice Address: | 1485 Commerce Park Drive Tipp City, OH - 45371 |
| Business Phone Number: | 9376675126 |
| Business Fax Number: | 9376677583 |
| Mailing Address: | 1485 Commerce Park Drive, TIPP CITY |
| State: | OH |
| Postal Code: | 45371 |
| Phone Number: | 9376675126 |
| Fax Number: | 9376677583 |
| NPI Enumeration Date: | 08/04/2006 |
| NPI Last Update Date: | 10/18/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 3768 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |