Healthcare Provider Details

I. General information

NPI: 1114721370
Provider Name (Legal Business Name): DYLAN R. NIEVES THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2025
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 MILLENNIUM PKWY STE 1037
BRANDON FL
33511-4861
US

IV. Provider business mailing address

1210 MILLENNIUM PKWY STE 1037
BRANDON FL
33511-4861
US

V. Phone/Fax

Practice location:
  • Phone: 656-233-3137
  • Fax:
Mailing address:
  • Phone: 656-233-3137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. DYLAN ROSENBERG NIEVES PALMA
Title or Position: LICENSED MENTAL HEALTH COUNSELOR
Credential: MS, LMHC, LCPC, LPC
Phone: 656-233-3137