Individual
AYALA BACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
701 CROSS ST, LAKEWOOD, NJ 08701-4029
(732) 267-7879
Mailing address
28 MELISSA LEE DR, JACKSON, NJ 08527-5151
(732) 267-7879
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
44SC05786100
NJ
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
10/04/2018
Last updated
03/15/2022
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