Healthcare Provider Details

I. General information

NPI: 1144519281
Provider Name (Legal Business Name): TRAVIS W ATKINSON L.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2011
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E LAS OLAS BLVD STE 130-733
FORT LAUDERDALE FL
33301-2210
US

IV. Provider business mailing address

215 PARK AVE S FL 11
NEW YORK NY
10003-1626
US

V. Phone/Fax

Practice location:
  • Phone: 212-725-7774
  • Fax:
Mailing address:
  • Phone: 212-725-7774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number052973
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: