1518147677 NPI number — GABRIELLE CELESTE AYALA LCSW

Table of content: GABRIELLE CELESTE AYALA LCSW (NPI 1518147677)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518147677 NPI number — GABRIELLE CELESTE AYALA LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AYALA
Provider First Name:
GABRIELLE
Provider Middle Name:
CELESTE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AYALA
Provider Other First Name:
GABRIELLE
Provider Other Middle Name:
ANTONIA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1518147677
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/06/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3009 N A ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33609-2350
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-277-4559
Provider Business Mailing Address Fax Number:
813-673-8946

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3009 N A ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33609-2350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-277-4559
Provider Business Practice Location Address Fax Number:
813-673-8946
Provider Enumeration Date:
11/06/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  FLORIDA LCSW 5715 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)