Provider Demographics
NPI:1962916528
Name:NELSON-SEASE, DYLAN (LPC)
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:
Last Name:NELSON-SEASE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 SPRING ST # B
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-2231
Mailing Address - Country:US
Mailing Address - Phone:515-351-0490
Mailing Address - Fax:
Practice Address - Street 1:9 N SALEM ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NJ
Practice Address - Zip Code:07801-4185
Practice Address - Country:US
Practice Address - Phone:201-841-0101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-18
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180011986101YM0800X
NY012290101YM0800X
NJ37PC00900100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health