| Travis Tanner | |
| 
					860 Lorimer St Apt 2c Brooklyn NY 11222-7531  | |
| (917) 909-2332 | |
| (917) 909-2340 | 
| Full Name | Travis Tanner | 
|---|---|
| Speciality | Social Worker - Clinical | 
| Location | 860 Lorimer St Apt 2c, Brooklyn, New York | 
| Authorized Official Name and Position | Travis Tanner (OWNER AND CLINICAL DIRECTOR) | 
| Authorized Official Contact | 9179092332 | 
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. | 
| Mailing Address | Practice Location Address | 
|---|---|
| Travis Tanner 860 Lorimer St Apt 2c Brooklyn NY 11222-7531 Ph: (917) 909-2332  | Travis Tanner 860 Lorimer St Apt 2c Brooklyn NY 11222-7531 Ph: (917) 909-2332  | 
| NPI Number | 1124752118 | 
|---|---|
| Provider Enumeration Date | 07/14/2022 | 
| Last Update Date | 07/14/2022 | 
| Certification Date | 07/14/2022 | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1124752118 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary | 
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