Provider Demographics
NPI:1528256831
Name:TRAVERS, NANCY A (LCSW)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:A
Last Name:TRAVERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2212 DUPONT DR
Mailing Address - Street 2:SUITE I
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-1525
Mailing Address - Country:US
Mailing Address - Phone:949-510-9423
Mailing Address - Fax:949-916-2978
Practice Address - Street 1:2212 DUPONT DR
Practice Address - Street 2:SUITE I
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-1525
Practice Address - Country:US
Practice Address - Phone:949-510-9423
Practice Address - Fax:949-916-2978
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS21005174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist