Provider Demographics
NPI:1609033737
Name:AYALA-BRISCOE, GLORIA PATRICIA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:PATRICIA
Last Name:AYALA-BRISCOE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:GLORIA
Other - Middle Name:PATRICIA
Other - Last Name:AYALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7777 S. FREEDOM ROAD
Mailing Address - Street 2:
Mailing Address - City:FRENCH CAMP
Mailing Address - State:CA
Mailing Address - Zip Code:95231
Mailing Address - Country:US
Mailing Address - Phone:916-477-8419
Mailing Address - Fax:
Practice Address - Street 1:7777 S. FREEDOM ROAD
Practice Address - Street 2:
Practice Address - City:FRENCH CAMP
Practice Address - State:CA
Practice Address - Zip Code:95231-9693
Practice Address - Country:US
Practice Address - Phone:916-477-8419
Practice Address - Fax:916-640-8094
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW862981041C0700X, 1041C0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCSW86298Medicaid