Provider Demographics
NPI:1760234686
Name:AYALA, JANESSA I
Entity Type:Individual
Prefix:
First Name:JANESSA
Middle Name:I
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 1:79 FRANKLIN ST APT 3
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-2254
Mailing Address - Country:US
Mailing Address - Phone:413-275-7550
Mailing Address - Fax:
Practice Address - Street 1:160 JOAN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01129-1530
Practice Address - Country:US
Practice Address - Phone:413-783-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician