Provider Demographics
NPI:1760907737
Name:AYALA, MYRIAM YADIRA (LICENSED CLINICAL SO)
Entity Type:Individual
Prefix:MRS
First Name:MYRIAM
Middle Name:YADIRA
Last Name:AYALA
Suffix:
Gender:F
Credentials:LICENSED CLINICAL SO
Other - Prefix:MRS
Other - First Name:MYRIAM
Other - Middle Name:Y
Other - Last Name:AYALA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1000 BRICKELL AVENUE- PMB 1431
Mailing Address - Street 2:SUITE 715
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131
Mailing Address - Country:US
Mailing Address - Phone:786-791-3080
Mailing Address - Fax:786-590-1931
Practice Address - Street 1:1000 BRICKELL AVENUE
Practice Address - Street 2:SUITE 715
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131
Practice Address - Country:US
Practice Address - Phone:786-791-3080
Practice Address - Fax:786-590-1931
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-10
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY085303-11041C0700X
FLSW146501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical