Active NPI
Travis Wade Cronin, LCSW
- Clinical Social Worker
- Mountain Home a F B, ID
National Provider Identifier
1811270697
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCSW 31117
- Practice address
- 90 Hope Dr
Mountain Home a F B, ID 83648-1057 - Phone
- (208) 828-7582
- NPI assigned
- Sep 27, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LCSW 31117 | ID | Primary |
Addresses
Primary practice location
90 Hope Dr
Mountain Home a F B, ID 83648-1057
Mailing address
90 Hope Dr
Mountain Home a F B, ID 83648-1057
Phone (208) 828-7582
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCSW 31117 | ID | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1317081600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1320537600000",
"number": "1811270697",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "90 HOPE DR",
"city": "MOUNTAIN HOME A F B",
"state": "ID",
"postal_code": "836481057",
"telephone_number": "208-828-7582"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "90 HOPE DR",
"city": "MOUNTAIN HOME A F B",
"state": "ID",
"postal_code": "836481057",
"telephone_number": "208-828-7582"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRONIN",
"first_name": "TRAVIS",
"middle_name": "WADE",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-09-27",
"last_updated": "2011-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "ID",
"license": "LCSW 31117",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mountain Home a F B, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.