Provider Demographics
NPI:1215791884
Name:BRAY, KELSEY ANN
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:ANN
Last Name:BRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 W 47TH ST APT 4B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-2382
Mailing Address - Country:US
Mailing Address - Phone:949-636-3044
Mailing Address - Fax:
Practice Address - Street 1:426 W 47TH ST APT 4B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-2382
Practice Address - Country:US
Practice Address - Phone:949-636-3044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101200000XBehavioral Health & Social Service ProvidersDrama Therapist