Provider Demographics
NPI:1649741331
Name:AYALA, AMARILYS
Entity Type:Individual
Prefix:
First Name:AMARILYS
Middle Name:
Last Name:AYALA
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 1:260 WESTFIELD RD
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-1662
Mailing Address - Country:US
Mailing Address - Phone:413-534-3299
Mailing Address - Fax:
Practice Address - Street 1:6000 TURKEY LAKE RD STE 114
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-4205
Practice Address - Country:US
Practice Address - Phone:321-732-3723
Practice Address - Fax:321-352-7168
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-06
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRBT-22-217908OtherRBT CERTIFICATE
FL114513600Medicaid