Provider Demographics
NPI:1053555631
Name:TRAVAGLIONE, PATRICIA DONOVAN (LCSW)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:DONOVAN
Last Name:TRAVAGLIONE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 DALY RD
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-6303
Mailing Address - Country:US
Mailing Address - Phone:631-433-1451
Mailing Address - Fax:631-980-4016
Practice Address - Street 1:100 MANETTO HILL RD
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-1311
Practice Address - Country:US
Practice Address - Phone:631-433-1451
Practice Address - Fax:516-931-2106
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-0485301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical