Provider Demographics
NPI:1689902033
Name:AYALA, ISAAC (MASTER'S)
Entity Type:Individual
Prefix:
First Name:ISAAC
Middle Name:
Last Name:AYALA
Suffix:
Gender:M
Credentials:MASTER'S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 ROUTE 6
Mailing Address - Street 2:PO BOX 200
Mailing Address - City:COLUMBIA
Mailing Address - State:CT
Mailing Address - Zip Code:06237-1125
Mailing Address - Country:US
Mailing Address - Phone:860-774-2020
Mailing Address - Fax:860-228-6921
Practice Address - Street 1:233 ROUTE 6
Practice Address - Street 2:DAYVILLE
Practice Address - City:COLUMBIA
Practice Address - State:CT
Practice Address - Zip Code:06237-1125
Practice Address - Country:US
Practice Address - Phone:860-774-2020
Practice Address - Fax:860-228-6921
Is Sole Proprietor?:No
Enumeration Date:2009-11-23
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1300881Medicaid
MA0300060OtherMBHP