Healthcare Provider Details

I. General information

NPI: 1053226548
Provider Name (Legal Business Name): BENJAMIN NIEVES-SERRANO RCSWI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BENJAMIN NIEVES RCSWI

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 W EAU GALLIE BLVD STE 96
MELBOURNE FL
32935-5390
US

IV. Provider business mailing address

398 BRECKENRIDGE CIR SE
PALM BAY FL
32909-2338
US

V. Phone/Fax

Practice location:
  • Phone: 727-413-0088
  • Fax:
Mailing address:
  • Phone: 727-413-0088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberISW23787
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: