Provider Demographics
NPI:1215150370
Name:TRAVIS, JANET LOUISE (LCSW)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:LOUISE
Last Name:TRAVIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:L
Other - Last Name:SALEH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:407 OMNI DR
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-4527
Mailing Address - Country:US
Mailing Address - Phone:908-281-8424
Mailing Address - Fax:908-281-6289
Practice Address - Street 1:407 OMNI DR
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-4527
Practice Address - Country:US
Practice Address - Phone:908-281-8424
Practice Address - Fax:908-281-6289
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC045233001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ736808Medicare ID - Type Unspecified