Provider Demographics
NPI:1235510751
Name:TRAVAGLINI, LETITIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:LETITIA
Middle Name:
Last Name:TRAVAGLINI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 N. GREENE ST.
Mailing Address - Street 2:ANNEX BUILDING, 7TH FL (MIRECC)
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201
Mailing Address - Country:US
Mailing Address - Phone:410-637-1867
Mailing Address - Fax:
Practice Address - Street 1:10 N. GREENE ST.
Practice Address - Street 2:ANNEX BUILDING, 7TH FL (MIRECC)
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201
Practice Address - Country:US
Practice Address - Phone:410-637-1867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06009103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical