Provider Demographics
NPI:1265180939
Name:NICELY, DWERLY TERESA (RBT)
Entity type:Individual
Prefix:MS
First Name:DWERLY
Middle Name:TERESA
Last Name:NICELY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:MS
Other - First Name:DWERLY
Other - Middle Name:TERESA
Other - Last Name:ABDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:21821 NW 6TH CT
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-1057
Mailing Address - Country:US
Mailing Address - Phone:954-235-6946
Mailing Address - Fax:
Practice Address - Street 1:15656 SW 53RD CT
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-4985
Practice Address - Country:US
Practice Address - Phone:954-401-3391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-12
Last Update Date:2022-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT21-196796106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst