Provider Demographics
NPI:1821722802
Name:BROWN, TRAVIS BRADLEY
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:BRADLEY
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 DAVIDSON AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-2346
Mailing Address - Country:US
Mailing Address - Phone:716-541-4129
Mailing Address - Fax:
Practice Address - Street 1:345 DAVIDSON AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-2346
Practice Address - Country:US
Practice Address - Phone:716-541-4129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical