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NPI Code Detail

MEDICARE: ANTONIA TRAVISANO PSY.D.

MEDICARE: ANTONIA TRAVISANO PSY.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist0810007634VA
2103TC0700XClinical PsychologistB1-0011441DE

General Provider Information

NPI Number : 1376162214
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANTONIA TRAVISANO PSY.D.
Provider Business Mailing Address
First Line : 100 COMMERCE DR
Second Line : BUILDING 100, STE 300
City : NEWARK
State : DE
Zip : 19713-2878
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 100 COMMERCE DR
Second Line : BUILDING 100, STE 300
City : NEWARK
State : DE
Zip : 19713-2878
Country : US
Telephone Number : 302-224-1400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2020
Last Update Date : 05/29/2024

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Directions to “ ANTONIA TRAVISANO PSY.D.” Practice Location

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