Provider Demographics
NPI:1225572571
Name:AYLWIN, IVANA
Entity Type:Individual
Prefix:
First Name:IVANA
Middle Name:
Last Name:AYLWIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SACO ST
Mailing Address - Street 2:UNIT 6
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02122-2646
Mailing Address - Country:US
Mailing Address - Phone:617-669-6149
Mailing Address - Fax:
Practice Address - Street 1:10 SACO ST
Practice Address - Street 2:UNIT 6
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-2646
Practice Address - Country:US
Practice Address - Phone:617-669-6149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health