MEDICARE: CAROLYN H BRAY PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY17970	CA

General Provider Information

NPI Number	:	1275391419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN H BRAY PHD

Provider Business Mailing Address
First Line	:	P.O. BOX 1638
Second Line	:
City	:	MILL VALLEY
State	:	CA
Zip	:	94942-1638
Country	:	US
Telephone Number	:	415-789-7658
Fax Number	:

Provider Business Practice Location Address
First Line	:	655 REDWOOD HWY
Second Line	:	SUITE 330
City	:	MILL VALLEY
State	:	CA
Zip	:	94941-3057
Country	:	US
Telephone Number	:	415-789-7658
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2024
Last Update Date	:	03/12/2024

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