Doctor Name: | MS. SUSAN L. TRAVIS |
NPI Number: | 1164555256 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A. |
License Number: | 00165-1 |
Business Practice Address: | 31 Laveta Pl Nyack, NY - 109601603 |
Business Phone Number: | 8453585560 |
Business Fax Number: | |
Mailing Address: | 31 Laveta Pl, NYACK |
State: | NY |
Postal Code: | 109601603 |
Phone Number: | 8453585560 |
Fax Number: | |
NPI Enumeration Date: | 03/14/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 00165-1 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |