Individual provider Active NPI

Sandra S Traviss, LCSW

  • Clinical Social Worker
  • Santa Rosa, CA
National Provider Identifier
1881744266
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCS5260 Issued in CA
Practice address
2455 Bennett Valley Rd
Suite 208B
Santa Rosa, CA 95404-5663
Phone
(707) 526-2595
Fax
(707) 539-6809
NPI assigned
Jan 10, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LCS5260 CA Primary

Addresses

Primary practice location

2455 Bennett Valley Rd
Suite 208B
Santa Rosa, CA 95404-5663

Mailing address

1825 San Ramon Way
Santa Rosa, CA 95409-3967
Phone (707) 526-2595

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

LicenseStateTypeSpecialty
LCS5260CAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Traviss Family Counseling Clinical PastSince Dec 6, 2015 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1881744266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1825 SAN RAMON WAY",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954093967",
            "telephone_number": "707-526-2595",
            "fax_number": "707-539-6809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2455 BENNETT VALLEY RD",
            "address_2": "SUITE 208B",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954045663",
            "telephone_number": "707-526-2595",
            "fax_number": "707-539-6809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRAVISS",
        "first_name": "SANDRA",
        "middle_name": "S",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-10",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCS5260",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.