Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1041C0700X | Clinical Social Worker | 116812 | MA |
Y | 1041C0700X | Clinical Social Worker | 44SC05484200 | NJ |
N | 1041S0200X | School Social Worker | 611272 | NJ |
N | 1041S0200X | School Social Worker | PPS-0603456 | VA |
NPI | 1003174673 |
---|---|
Provider Name | Alicia M Ayvas |
First Address | Hasbrouck Heights, NJ 07604-1802 |
Second Address | Hasbrouck Heights, NJ 07604-1802 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2012 |
Last Update Date | 02/05/2012 |