Provider Demographics
NPI:1457121964
Name:AYALA, MARYSOL (LMHC)
Entity Type:Individual
Prefix:
First Name:MARYSOL
Middle Name:
Last Name:AYALA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 S ROUTE 9W STE 41
Mailing Address - Street 2:
Mailing Address - City:WEST HAVERSTRAW
Mailing Address - State:NY
Mailing Address - Zip Code:10993-1053
Mailing Address - Country:US
Mailing Address - Phone:718-781-4947
Mailing Address - Fax:
Practice Address - Street 1:312 RICHARD CT
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-2310
Practice Address - Country:US
Practice Address - Phone:718-781-4947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP111472101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health