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General NPI Number Information
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NPI Number | 1699710509
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Entity Type | Individual
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Provider Name | TIMOTHY C. BRAY PH.D.
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Gender | Male
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Dates
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Enumeration Date | 06/17/2006
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Last Update Date | 09/21/2021
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Provider Practice Location Address
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Address Line | 76 NORTHEASTERN BLVD STE 36A
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City | NASHUA
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State | NH
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Zip | 03062-3196
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Country | US
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Telephone | 603-881-7554
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Fax | 603-881-7533
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Provider Business Mailing Address
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Address Line | WILLOWDALE COUNSELING CENTER 76 NORTHEASTERN BOULEVARD, UNIT 36A
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City | NASHUA
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State | NH
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Zip | 03062-3196
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Country | US
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Telephone | 603-881-7554
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Fax | 603-881-7533
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 7920
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 941
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License Number State | NH
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