Provider Demographics
NPI:1770240624
Name:STEPHANIE TRAVER
Entity Type:Organization
Organization Name:STEPHANIE TRAVER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-371-4512
Mailing Address - Street 1:664 RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-5518
Mailing Address - Country:US
Mailing Address - Phone:121-393-2273
Mailing Address - Fax:
Practice Address - Street 1:664 RIDGE ST
Practice Address - Street 2:
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566-5518
Practice Address - Country:US
Practice Address - Phone:121-393-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-25
Last Update Date:2022-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty