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General NPI Number Information
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NPI Number | 1114202157
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Entity Type | Individual
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Provider Name | BRYNA RAQUEL MAY LPC
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Gender | Female
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Dates
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Enumeration Date | 10/20/2011
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Last Update Date | 03/12/2020
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Provider Practice Location Address
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Address Line | 1333 STRAD AVE STE 109
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City | NORTH TONAWANDA
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State | NY
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Zip | 14120-3061
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Country | US
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Telephone | 716-253-2704
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Fax |
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Provider Business Mailing Address
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Address Line | 1585 RUIE RD
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City | NORTH TONAWANDA
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State | NY
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Zip | 14120-1841
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Country | US
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Telephone | 716-253-2704
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 008419
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701004941
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License Number State | VA
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