Provider Demographics
NPI:1982329827
Name:AMAYA, INGRID PAOLA
Entity type:Individual
Prefix:
First Name:INGRID
Middle Name:PAOLA
Last Name:AMAYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 NEWPORT PKWY APT 1805
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07310-1565
Mailing Address - Country:US
Mailing Address - Phone:646-883-4168
Mailing Address - Fax:
Practice Address - Street 1:121 NEWARK AVE STE 410
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-5873
Practice Address - Country:US
Practice Address - Phone:201-240-6186
Practice Address - Fax:201-763-6606
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0918761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty