Healthcare Provider Details

I. General information

NPI: 1790423416
Provider Name (Legal Business Name): BRITTANY TRAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2022
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 WATER ST STE 1
WAKEFIELD MA
01880-3044
US

IV. Provider business mailing address

37 WATER ST STE 1
WAKEFIELD MA
01880-3044
US

V. Phone/Fax

Practice location:
  • Phone: 561-451-5952
  • Fax:
Mailing address:
  • Phone: 561-451-5952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: