Provider Demographics
NPI:1790348464
Name:BRENDLE-AYALA, MOLLY JANE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:JANE
Last Name:BRENDLE-AYALA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 PARK COMMONS CT APT I
Mailing Address - Street 2:
Mailing Address - City:VALLEY PARK
Mailing Address - State:MO
Mailing Address - Zip Code:63088-2504
Mailing Address - Country:US
Mailing Address - Phone:314-705-2176
Mailing Address - Fax:
Practice Address - Street 1:10845 OLIVE BLVD STE 150
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-7760
Practice Address - Country:US
Practice Address - Phone:314-561-9757
Practice Address - Fax:314-561-9050
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20180430571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical