Provider Demographics
NPI:1760026405
Name:TRAVIS-BEY, LATIFAH FATIMA (MS)
Entity Type:Individual
Prefix:
First Name:LATIFAH
Middle Name:FATIMA
Last Name:TRAVIS-BEY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 ARCH ST FL 6
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-2835
Mailing Address - Country:US
Mailing Address - Phone:215-981-3311
Mailing Address - Fax:
Practice Address - Street 1:1216 ARCH ST FL 6
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-2835
Practice Address - Country:US
Practice Address - Phone:215-981-3311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1036888220001Medicaid