Provider Demographics
NPI:1134147960
Name:TRAVIS, JUDITH (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:
Last Name:TRAVIS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 BRIDGE PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-1735
Mailing Address - Country:US
Mailing Address - Phone:732-617-2177
Mailing Address - Fax:732-617-2176
Practice Address - Street 1:405 BRIDGE PLAZA DR
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-1735
Practice Address - Country:US
Practice Address - Phone:732-617-2177
Practice Address - Fax:732-617-2176
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC000185001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ089437Medicare ID - Type Unspecified