Provider Demographics
NPI:1467462937
Name:BRAY, JAY EARL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:EARL
Last Name:BRAY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 S EL CAMINO REAL
Mailing Address - Street 2:SUITE 624
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-1726
Mailing Address - Country:US
Mailing Address - Phone:650-562-1144
Mailing Address - Fax:650-618-1718
Practice Address - Street 1:520 S EL CAMINO REAL
Practice Address - Street 2:SUITE 624
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-1726
Practice Address - Country:US
Practice Address - Phone:650-562-1144
Practice Address - Fax:650-618-1718
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW 5353101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health