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General NPI Number Information
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NPI Number | 1720734593
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Entity Type | Individual
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Provider Name | IVETTE AYALA
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Gender | Female
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Dates
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Enumeration Date | 03/01/2022
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Last Update Date | 05/13/2022
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Provider Practice Location Address
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Address Line | 1600 CENTRAL AVE
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City | FAR ROCKAWAY
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State | NY
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Zip | 11691-4000
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Country | US
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Telephone | 917-848-4792
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Fax |
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Provider Business Mailing Address
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Address Line | 12205 FLATLANDS AVE APT 5F
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City | BROOKLYN
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State | NY
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Zip | 11207-9051
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Country | US
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Telephone | 917-582-1481
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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