Provider Demographics
NPI:1336743145
Name:INCLUSION ONLINE THERAPY CORP
Entity Type:Organization
Organization Name:INCLUSION ONLINE THERAPY CORP
Other - Org Name:MYRIAM AYALA ONLINE THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MYRIAM
Authorized Official - Middle Name:YADIRA
Authorized Official - Last Name:AYALA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:917-734-2578
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 BRICKEL
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-23
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty