Provider Demographics
NPI:1093281883
Name:AYALA PENALOZA, DAED LIZBETH I (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:DAED
Middle Name:LIZBETH
Last Name:AYALA PENALOZA
Suffix:I
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:DAED
Other - Middle Name:LIZBETH
Other - Last Name:AYALA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:4238 N 17TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-5324
Mailing Address - Country:US
Mailing Address - Phone:928-261-5587
Mailing Address - Fax:
Practice Address - Street 1:1934 E CAMELBACK RD STE 197
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4126
Practice Address - Country:US
Practice Address - Phone:928-261-5587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-18
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-171291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical