Provider Demographics
NPI:1891790820
Name:TRAVIS CORP
Entity Type:Organization
Organization Name:TRAVIS CORP
Other - Org Name:PEOPLE CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT OF BEHAVIORAL HEALTH
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:617-441-1816
Mailing Address - Street 1:950 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02141-1001
Mailing Address - Country:US
Mailing Address - Phone:617-441-1816
Mailing Address - Fax:617-494-0520
Practice Address - Street 1:950 CAMBRIDGE ST.
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02141
Practice Address - Country:US
Practice Address - Phone:617-441-1816
Practice Address - Fax:617-494-0520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4211261Q00000X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Not Answered261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)