Provider Demographics
NPI:1609199843
Name:WINTER, TRAVIS F (LCSW-R)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:F
Last Name:WINTER
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 WARREN RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1862
Mailing Address - Country:US
Mailing Address - Phone:607-257-1555
Mailing Address - Fax:607-257-2510
Practice Address - Street 1:555 WARREN RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1862
Practice Address - Country:US
Practice Address - Phone:607-257-1555
Practice Address - Fax:607-257-2510
Is Sole Proprietor?:No
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0572941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical