Provider Demographics
NPI:1497859607
Name:BRAY, MARIE ELENA (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:ELENA
Last Name:BRAY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:ELENA
Other - Last Name:BRIGIDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:130 DUNHAM STREET
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489
Mailing Address - Country:US
Mailing Address - Phone:860-637-0947
Mailing Address - Fax:
Practice Address - Street 1:51 N MAIN STREET
Practice Address - Street 2:STE 1A
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489
Practice Address - Country:US
Practice Address - Phone:860-637-0947
Practice Address - Fax:860-276-8670
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000795106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT292739OtherMHN
CT410000795CT04OtherANTHEM
CT7470464OtherAETNA