Provider Demographics
NPI:1912428376
Name:BRAY, SHESHEENA
Entity Type:Individual
Prefix:
First Name:SHESHEENA
Middle Name:
Last Name:BRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 W MONTGOMERY AVE APT 8B
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-3354
Mailing Address - Country:US
Mailing Address - Phone:267-259-1740
Mailing Address - Fax:
Practice Address - Street 1:1735 MARKET ST STE 3750
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-7532
Practice Address - Country:US
Practice Address - Phone:267-259-1740
Practice Address - Fax:267-259-1740
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-06
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health