Provider Demographics
NPI:1528817160
Name:BRAY, MARYAM
Entity type:Individual
Prefix:
First Name:MARYAM
Middle Name:
Last Name:BRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 RUSS ST APT N120
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-1484
Mailing Address - Country:US
Mailing Address - Phone:959-255-7533
Mailing Address - Fax:
Practice Address - Street 1:140 RUSS ST APT N120
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-1484
Practice Address - Country:US
Practice Address - Phone:959-255-7533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician