Provider Demographics
NPI:1558649459
Name:TRAVIS, VICTORIA W (LCSW)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:W
Last Name:TRAVIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 E 57TH ST
Mailing Address - Street 2:APARTMENT 9A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2953
Mailing Address - Country:US
Mailing Address - Phone:516-382-5143
Mailing Address - Fax:
Practice Address - Street 1:3 W 29TH ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-4504
Practice Address - Country:US
Practice Address - Phone:212-725-7850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-26
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029321-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical