Provider Demographics
NPI:1013995968
Name:TRAVERS, COLEEN (LCSW, ACSW)
Entity Type:Individual
Prefix:MS
First Name:COLEEN
Middle Name:
Last Name:TRAVERS
Suffix:
Gender:F
Credentials:LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 WELCH RD, SUITE A-1, MC 5776
Mailing Address - Street 2:STANFORD COORDINATED CARE
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94304
Mailing Address - Country:US
Mailing Address - Phone:650-736-2613
Mailing Address - Fax:650-724-2550
Practice Address - Street 1:1101 WELCH RD
Practice Address - Street 2:SUITE A-1, MC 5776
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1904
Practice Address - Country:US
Practice Address - Phone:650-736-2613
Practice Address - Fax:650-724-2550
Is Sole Proprietor?:No
Enumeration Date:2006-01-01
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA260681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical