Provider Demographics
NPI:1407903685
Name:TRAVASSOS, FRANK JR (LICSW)
Entity Type:Individual
Prefix:MR
First Name:FRANK
Middle Name:
Last Name:TRAVASSOS
Suffix:JR
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 COLONIAL RD
Mailing Address - Street 2:#9
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-1971
Mailing Address - Country:US
Mailing Address - Phone:774-217-0138
Mailing Address - Fax:
Practice Address - Street 1:14 COLONIAL RD
Practice Address - Street 2:#9
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-1971
Practice Address - Country:US
Practice Address - Phone:774-217-0138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA210198104100000X
MA1141151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker