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Individual

DIANE M BRAY

Active
Sole proprietor

Provider details

NPI number
Gender
F
Credential
APRN, BC

Contact information

Practice address
664 PROSPECT AVE, HARTFORD, CT 06105-4203
(860) 236-8087
(860) 586-7422
Mailing address
554 NILES RD, NEW HARTFORD, CT 06057-2412
(860) 379-7154

Taxonomy

Speciality
Code
Description
License number
State
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
Primary
000772
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
134533
VALUE OPTIONS
CT
01
188780
MHN
CT
01
400000772-CT01
BLUE CROSS/ BLUE SHIELD
CT
01
400000772-CT02
BLUE CROSS/ BLUE SHIELD
CT
01
4556305
AETNA
CT
01
P1935240
OXFORD
CT
Enumeration date
06/06/2006
Last updated
07/08/2007
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