Provider Demographics
NPI:1699710509
Name:BRAY, TIMOTHY C (PHD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:C
Last Name:BRAY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WILLOWDALE COUNSELING CENTER
Mailing Address - Street 2:76 NORTHEASTERN BOULEVARD, UNIT 36A
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-3196
Mailing Address - Country:US
Mailing Address - Phone:603-881-7554
Mailing Address - Fax:603-881-7533
Practice Address - Street 1:76 NORTHEASTERN BLVD STE 36A
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-3196
Practice Address - Country:US
Practice Address - Phone:603-881-7554
Practice Address - Fax:603-881-7533
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7920103TC0700X
NH941103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30421223Medicaid
NH06Y000951NH01OtherBEHAVIORAL HEALTH NETWORK
NH30421223Medicaid