1275866154 NPI number — MRS. TIFFANY L. TRAVERS LCSW-C

Table of content: MRS. TIFFANY L. TRAVERS LCSW-C (NPI 1275866154)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275866154 NPI number — MRS. TIFFANY L. TRAVERS LCSW-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRAVERS
Provider First Name:
TIFFANY
Provider Middle Name:
L.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TRAVERS
Provider Other First Name:
TIFFANY
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW-C
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1275866154
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 E CARROLL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21801-5422
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-546-6400
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 E CARROLL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21801-5422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-546-6400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/10/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  14226 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 068375200 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 119591300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com