Provider Demographics
NPI:1609518547
Name:BARRET, TRAVIS WALKER (LCSW)
Entity Type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:WALKER
Last Name:BARRET
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BARRET LN
Mailing Address - Street 2:
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-1158
Mailing Address - Country:US
Mailing Address - Phone:860-395-8714
Mailing Address - Fax:
Practice Address - Street 1:70 HOLMES DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3937
Practice Address - Country:US
Practice Address - Phone:860-262-5509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0083091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty