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General NPI Number Information
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NPI Number | 1457121964
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Entity Type | Individual
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Provider Name | MARYSOL AYALA LMHC
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Gender | Female
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Dates
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Enumeration Date | 01/05/2024
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Last Update Date | 01/05/2024
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Provider Practice Location Address
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Address Line | 312 RICHARD CT
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City | POMONA
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State | NY
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Zip | 10970-2310
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Country | US
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Telephone | 718-781-4947
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Fax |
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Provider Business Mailing Address
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Address Line | 45 S ROUTE 9W STE 41
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City | WEST HAVERSTRAW
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State | NY
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Zip | 10993-1053
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Country | US
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Telephone | 718-781-4947
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | P111472
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License Number State | NY
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