Provider Demographics
NPI:1679007124
Name:GOODWIN, TRAVA (LCSW)
Entity Type:Individual
Prefix:
First Name:TRAVA
Middle Name:
Last Name:GOODWIN
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 1:4470 W SUNSET BLVD
Mailing Address - Street 2:STE 107 PMB94731
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6309
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:866-280-0260
Practice Address - Street 1:4470 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6302
Practice Address - Country:US
Practice Address - Phone:833-419-0181
Practice Address - Fax:833-419-0181
Is Sole Proprietor?:No
Enumeration Date:2017-04-11
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1099911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical