Provider Demographics
NPI:1144941527
Name:BRAYTON, MARIA LYNNE (LMHC)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:LYNNE
Last Name:BRAYTON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:IRELAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:FORT EDWARD
Mailing Address - State:NY
Mailing Address - Zip Code:12828-1730
Mailing Address - Country:US
Mailing Address - Phone:518-681-0884
Mailing Address - Fax:
Practice Address - Street 1:12 CANAL ST
Practice Address - Street 2:
Practice Address - City:FORT EDWARD
Practice Address - State:NY
Practice Address - Zip Code:12828-1730
Practice Address - Country:US
Practice Address - Phone:518-681-0884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012407101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health