Provider Demographics
NPI:1568741841
Name:TRAVIA, TARA LUV
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:LUV
Last Name:TRAVIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9480 MAIN ST # 1250
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4032
Mailing Address - Country:US
Mailing Address - Phone:724-664-9943
Mailing Address - Fax:
Practice Address - Street 1:2132 GLENCOURSE LN # 1250
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-1315
Practice Address - Country:US
Practice Address - Phone:724-664-9943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA016169103TC0700X
VA0810004442103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical