Provider Demographics
NPI:1043472566
Name:DAVIS, TRAVIS LAMONT (BSW)
Entity type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:LAMONT
Last Name:DAVIS
Suffix:
Gender:M
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 S DIXIE HWY
Mailing Address - Street 2:SUITE 1140
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2926
Mailing Address - Country:US
Mailing Address - Phone:305-668-9000
Mailing Address - Fax:305-662-1788
Practice Address - Street 1:1320 S DIXIE HWY
Practice Address - Street 2:SUITE 1140
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2926
Practice Address - Country:US
Practice Address - Phone:305-668-9000
Practice Address - Fax:305-662-1788
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker