Healthcare Provider Details

I. General information

NPI: 1891790820
Provider Name (Legal Business Name): TRAVIS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 CAMBRIDGE ST.
CAMBRIDGE MA
02141
US

IV. Provider business mailing address

950 CAMBRIDGE ST
CAMBRIDGE MA
02141-1001
US

V. Phone/Fax

Practice location:
  • Phone: 617-441-1816
  • Fax: 617-494-0520
Mailing address:
  • Phone: 617-441-1816
  • Fax: 617-494-0520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number4211
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number4211
License Number StateMA

VIII. Authorized Official

Name: MR. MICHAEL MARTINI
Title or Position: VICE-PRESIDENT OF BEHAVIORAL HEALTH
Credential: PH.D
Phone: 617-441-1816