Healthcare Provider Details

I. General information

NPI: 1801713953
Provider Name (Legal Business Name): AMY BRALEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5016 W GENESEE ST
CAMILLUS NY
13031-2356
US

IV. Provider business mailing address

7556 COUNTY ROAD 153
INTERLAKEN NY
14847-9647
US

V. Phone/Fax

Practice location:
  • Phone: 315-217-1369
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberP143896
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: