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General NPI Number Information
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NPI Number | 1679007124
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Entity Type | Individual
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Provider Name | TRAVA GOODWIN LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/11/2017
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Last Update Date | 06/22/2023
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Provider Practice Location Address
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Address Line | 4470 W SUNSET BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90027-6302
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Country | US
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Telephone | 833-419-0181
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Fax | 833-419-0181
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Provider Business Mailing Address
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Address Line | 4470 W SUNSET BLVD STE 107 PMB94731
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City | LOS ANGELES
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State | CA
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Zip | 90027-6309
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Country | US
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Telephone |
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Fax | 866-280-0260
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 109991
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License Number State | CA
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