Individual
KAETLYNN M AYALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
584 STATE RT 17, RIDGEWOOD, NJ 07450-2000
(201) 556-8210
Mailing address
584 STATE RT 17, RIDGEWOOD, NJ 07450-2000
(201) 556-8210
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
44SL06642500
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
44SL06642500
STATE LICENSE
NJ
Enumeration date
03/25/2022
Last updated
06/15/2023
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