Provider Demographics
NPI:1396761284
Name:HUSSEY, TRAVIS O (LCSW)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:O
Last Name:HUSSEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:FORT FAIRFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04742-1021
Mailing Address - Country:US
Mailing Address - Phone:207-768-4718
Mailing Address - Fax:207-768-4738
Practice Address - Street 1:23 HIGH ST
Practice Address - Street 2:
Practice Address - City:FORT FAIRFIELD
Practice Address - State:ME
Practice Address - Zip Code:04742-1021
Practice Address - Country:US
Practice Address - Phone:207-768-4718
Practice Address - Fax:207-768-4738
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC8168104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEME0337Medicare PIN