Provider Demographics
NPI:1811525751
Name:AYALA MARQUEZ, JAYSON GIOVANNIE (MA)
Entity type:Individual
Prefix:MR
First Name:JAYSON
Middle Name:GIOVANNIE
Last Name:AYALA MARQUEZ
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1148 ELIZABETH AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4359
Mailing Address - Country:US
Mailing Address - Phone:717-390-9086
Mailing Address - Fax:717-390-9066
Practice Address - Street 1:1148 ELIZABETH AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4359
Practice Address - Country:US
Practice Address - Phone:717-390-9086
Practice Address - Fax:717-390-9066
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1102899457Medicaid