Provider Demographics
NPI:1164080271
Name:ATWATER, TRAVIS JORDAN (MSW, CRPA-P)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:JORDAN
Last Name:ATWATER
Suffix:
Gender:M
Credentials:MSW, CRPA-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14611-2335
Mailing Address - Country:US
Mailing Address - Phone:585-627-1777
Mailing Address - Fax:585-625-0843
Practice Address - Street 1:835 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14611-2335
Practice Address - Country:US
Practice Address - Phone:585-627-1777
Practice Address - Fax:585-625-0843
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)