Provider Demographics
NPI:1700215472
Name:BRAY, AMY LYNN (LMSW)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:LYNN
Last Name:BRAY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 PARK ST
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-2075
Mailing Address - Country:US
Mailing Address - Phone:810-624-7258
Mailing Address - Fax:
Practice Address - Street 1:706 PARK ST
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-2075
Practice Address - Country:US
Practice Address - Phone:810-624-7258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801094551104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker