Provider Demographics
NPI:1659852390
Name:NIEVES PALMA, DYLAN ROSENBERG (MS;LCPC;LPC;LMHC)
Entity Type:Individual
Prefix:MRS
First Name:DYLAN
Middle Name:ROSENBERG
Last Name:NIEVES PALMA
Suffix:
Gender:F
Credentials:MS;LCPC;LPC;LMHC
Other - Prefix:MS
Other - First Name:DYLAN
Other - Middle Name:SARAH
Other - Last Name:ROSENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS;LCPC;LPC;LMHC
Mailing Address - Street 1:1414 TRAIL BOSS LN.
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511
Mailing Address - Country:US
Mailing Address - Phone:340-514-8181
Mailing Address - Fax:
Practice Address - Street 1:1414 TRAIL BOSS LN.
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511
Practice Address - Country:US
Practice Address - Phone:340-514-8181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-21
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLG8858101YM0800X
FLMH18345101YP2500X
DCPRC200001334101YP2500X
MDLC10515101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health