Provider Demographics
NPI:1487924569
Name:BRAY, SUSAN B (PHD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:B
Last Name:BRAY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 SAN RAMON VALLEY BLVD
Mailing Address - Street 2:SUITE 4-173
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-5381
Mailing Address - Country:US
Mailing Address - Phone:925-322-3767
Mailing Address - Fax:
Practice Address - Street 1:145 E PROSPECT AVE
Practice Address - Street 2:SUITE 218
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-3868
Practice Address - Country:US
Practice Address - Phone:925-322-3767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20880103TB0200X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral