Healthcare Provider Details

I. General information

NPI: 1447155635
Provider Name (Legal Business Name): JAIME TRAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

869 MAIN ST
WALPOLE MA
02081-2985
US

IV. Provider business mailing address

230 UNION ST
FRANKLIN MA
02038-2132
US

V. Phone/Fax

Practice location:
  • Phone: 508-794-5188
  • Fax: 781-327-2703
Mailing address:
  • Phone: 508-794-5188
  • Fax: 781-327-2703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: