| Blue Dandelion Integrative Therapy, Llc | |
|
2803 Mancina Ct West Melbourne FL 32904-5707 | |
| (321) 537-4467 | |
| Not Available |
| Full Name | Blue Dandelion Integrative Therapy, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 2803 Mancina Ct, West Melbourne, Florida |
| Authorized Official Name and Position | Diliana B Polanco (OWNER) |
| Authorized Official Contact | 3213436773 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Dandelion Integrative Therapy, Llc 2803 Mancina Ct West Melbourne FL 32904-5707 Ph: (321) 343-6773 | Blue Dandelion Integrative Therapy, Llc 2803 Mancina Ct West Melbourne FL 32904-5707 Ph: (321) 537-4467 |
| NPI Number | 1801410170 |
|---|---|
| Provider Enumeration Date | 06/02/2020 |
| Last Update Date | 02/12/2025 |
| Certification Date | 02/12/2025 |
| Medicare PECOS PAC ID | 0941622831 |
|---|---|
| Medicare Enrollment ID | O20200623001203 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801410170 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (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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