Provider Demographics
NPI:1598005852
Name:GARRITY, TRAVER (LAC)
Entity type:Individual
Prefix:
First Name:TRAVER
Middle Name:
Last Name:GARRITY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:384 MERROW RD STE P
Mailing Address - Street 2:
Mailing Address - City:TOLLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06084-3970
Mailing Address - Country:US
Mailing Address - Phone:860-995-0317
Mailing Address - Fax:
Practice Address - Street 1:384 MERROW RD STE P
Practice Address - Street 2:
Practice Address - City:TOLLAND
Practice Address - State:CT
Practice Address - Zip Code:06084-3970
Practice Address - Country:US
Practice Address - Phone:860-995-0317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-25
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT568171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist