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Organization
BLUE IRIS BEHAVIORAL SERVICES CORP
Active
Organization
BLUE IRIS BEHAVIORAL SERVICES CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DILIANA B POLANCO LCSW (PRESIDENT)
(321) 537-4467
Entity
Organization
Contact information
Practice address
4640 LIPSCOMB ST NE STE 4, PALM BAY, FL 32905-2986
(321) 537-4467
Mailing address
4640 LIPSCOMB ST NE STE 4, PALM BAY, FL 32905-2986
(321) 537-4467
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
12/08/2021
Last updated
12/08/2021
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