Provider Demographics
NPI:1164939237
Name:BRAY, MADISON BUCHANAN (LMHC, MA, MED)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:BUCHANAN
Last Name:BRAY
Suffix:
Gender:F
Credentials:LMHC, MA, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 W 25TH ST FL 11
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-7405
Mailing Address - Country:US
Mailing Address - Phone:212-335-2100
Mailing Address - Fax:646-775-4142
Practice Address - Street 1:138 W 25TH ST FL 11
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-7405
Practice Address - Country:US
Practice Address - Phone:212-335-2100
Practice Address - Fax:646-775-4142
Is Sole Proprietor?:No
Enumeration Date:2018-01-10
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010898101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health