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General NPI Number Information
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NPI Number | 1760638498
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Entity Type | Individual
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Provider Name | DYLAN S MARIAH RN, LMHC
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Gender | Female
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Dates
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Enumeration Date | 08/13/2008
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Last Update Date | 04/10/2020
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Provider Practice Location Address
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Address Line | 20 OFFICE PARK WAY STE 107
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City | PITTSFORD
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State | NY
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Zip | 14534
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Country | US
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Telephone | 585-200-4646
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Fax |
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Provider Business Mailing Address
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Address Line | 5 STARLIGHT CIR
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City | FAIRPORT
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State | NY
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Zip | 14450-9330
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Country | US
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Telephone | 585-200-4646
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 002604
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 543015-1
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License Number State | NY
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