Provider Demographics
NPI:1164572509
Name:TRAVES, LOUISE DEBORAH (LCSW)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:DEBORAH
Last Name:TRAVES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:TRAVES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1001 DOVE ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2838
Mailing Address - Country:US
Mailing Address - Phone:949-551-1506
Mailing Address - Fax:949-551-3913
Practice Address - Street 1:1001 DOVE ST
Practice Address - Street 2:SUITE 140
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2838
Practice Address - Country:US
Practice Address - Phone:949-551-1506
Practice Address - Fax:949-551-3913
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS114661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical