| Blue Iris Behavioral Services Corp | |
|
4640 Lipscomb St Ne Ste 4 Palm Bay FL 32905-2986 | |
| (321) 537-4467 | |
| Not Available |
| Full Name | Blue Iris Behavioral Services Corp |
|---|---|
| Speciality | Behavior Analyst |
| Location | 4640 Lipscomb St Ne Ste 4, Palm Bay, Florida |
| Authorized Official Name and Position | Diliana B Polanco (PRESIDENT) |
| Authorized Official Contact | 3215374467 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Iris Behavioral Services Corp 4640 Lipscomb St Ne Ste 4 Palm Bay FL 32905-2986 Ph: (321) 537-4467 | Blue Iris Behavioral Services Corp 4640 Lipscomb St Ne Ste 4 Palm Bay FL 32905-2986 Ph: (321) 537-4467 |
| NPI Number | 1023777935 |
|---|---|
| Provider Enumeration Date | 12/08/2021 |
| Last Update Date | 12/08/2021 |
| Certification Date | 12/08/2021 |
| Medicare PECOS PAC ID | 5395129209 |
|---|---|
| Medicare Enrollment ID | O20220826000278 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023777935 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
| Provider Name | Diliana B Polanco |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477018331 PECOS PAC ID: 9830511724 Enrollment ID: I20200623001307 |
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