Ayala Back, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

44SC05786100 Issued in NJ

Practice address

701 Cross St
Lakewood, NJ 08701-4029

Phone

(732) 267-7879

NPI assigned

Oct 4, 2018

Last updated

Mar 15, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1538611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647302400000",
    "number": "1073088159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28 MELISSA LEE DR",
            "city": "JACKSON",
            "state": "NJ",
            "postal_code": "085275151",
            "telephone_number": "732-267-7879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 CROSS ST",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087014029",
            "telephone_number": "732-267-7879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACK",
        "first_name": "AYALA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-04",
        "last_updated": "2022-03-15",
        "certification_date": "2022-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": "44SC05786100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Azevedo
• Babybalance Birth
• Bacharach Eye Care LLC
• Moshe Bacharach, MD
• Aliza Back
• Fradi J. Back, RN
• Yehudis Backenroth
• Shoshana Bacon, M.D.
• Teddy Bahary, BCBA
• Aliza Baida, MS.ED, BCBA, LBA

• Clinical Social Worker in Lakewood, NJ
• Providers in Lakewood, NJ by specialty
• Clinical Social Worker in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.