MEDICARE: MR. TRAVIS W ATKINSON L.C.S.W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	052973	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	052973	OTHER	NY	NEW YORK STATE EDUCATION DEPARTMENT
2	089.0134684	OTHER	VT	VERMONT OFFICE OF PROFESSIONAL REGULATION

General Provider Information

NPI Number	:	1144519281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TRAVIS W ATKINSON L.C.S.W.

Provider Business Mailing Address
First Line	:	215 PARK AVE S FL 11
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10003-1626
Country	:	US
Telephone Number	:	212-725-7774
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 E LAS OLAS BLVD STE 130-733
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2210
Country	:	US
Telephone Number	:	212-725-7774
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2011
Last Update Date	:	08/28/2024

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