Provider Demographics
NPI:1316373285
Name:BRAY, DANETTE P (LMHC, CAP)
Entity type:Individual
Prefix:MRS
First Name:DANETTE
Middle Name:P
Last Name:BRAY
Suffix:
Gender:F
Credentials:LMHC, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:775 CARNATION DR
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-4988
Mailing Address - Country:US
Mailing Address - Phone:401-207-4039
Mailing Address - Fax:
Practice Address - Street 1:1986 31ST AVE
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6628
Practice Address - Country:US
Practice Address - Phone:888-975-3422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00572101YM0800X
RIACDP101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health