Provider Demographics
NPI:1013716448
Name:AYALA, ALICIA DEJA
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:DEJA
Last Name:AYALA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103-1346
Mailing Address - Country:US
Mailing Address - Phone:401-543-8840
Mailing Address - Fax:
Practice Address - Street 1:152 CENTER ST
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01013-1611
Practice Address - Country:US
Practice Address - Phone:413-540-1234
Practice Address - Fax:413-538-5169
Is Sole Proprietor?:No
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator