Provider Demographics
NPI:1275391419
Name:BRAY, CAROLYN H (PHD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:H
Last Name:BRAY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:HARKEY
Other - Last Name:BRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1638
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94942-1638
Mailing Address - Country:US
Mailing Address - Phone:415-789-7658
Mailing Address - Fax:
Practice Address - Street 1:655 REDWOOD HWY
Practice Address - Street 2:SUITE 330
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-3057
Practice Address - Country:US
Practice Address - Phone:415-789-7658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17970103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty