Provider Demographics
NPI:1801872189
Name:BRAY, LINDA JANE (LCSW)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:JANE
Last Name:BRAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:JANE
Other - Last Name:MERWARTH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:HCR 1 BOX 152
Mailing Address - Street 2:EAST TERRACE RD
Mailing Address - City:SAYLORSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18353-9312
Mailing Address - Country:US
Mailing Address - Phone:570-992-6311
Mailing Address - Fax:
Practice Address - Street 1:492 ROUTE 57 W
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07882-4338
Practice Address - Country:US
Practice Address - Phone:908-689-1000
Practice Address - Fax:908-639-4529
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC014726001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
2321561000OtherAMERIHEALTH
195910OtherMHN
2321561000OtherAMERIHEALTH