Healthcare Provider Details

I. General information

NPI: 1083607964
Provider Name (Legal Business Name): JENNIFER ANNE SCHULTZ BRAY LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 05/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 PONDVIEW PL
TYNGSBORO MA
01879-1068
US

IV. Provider business mailing address

80 WEST ST
PEPPERELL MA
01463-1230
US

V. Phone/Fax

Practice location:
  • Phone: 978-649-9980
  • Fax:
Mailing address:
  • Phone: 978-925-9293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4769
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number609
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: