NPIMap

Organization Active NPI

Blue Iris Behavioral Services Corp

  • Behavior Analyst
  • Palm Bay, FL
National Provider Identifier
1023777935
Registry record updated Dec 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
Legal business name
BLUE IRIS BEHAVIORAL SERVICES CORP
Practice address
4640 Lipscomb St NE Ste 4
Palm Bay, FL 32905-2986
Phone
(321) 537-4467
NPI assigned
Dec 8, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Diliana B Polanco, LCSWNPI 1477018331
Title
President
Phone
(321) 537-4467

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior AnalystGroup: 193400000X SINGLE SPECIALTY GROUP 103K00000X Primary

Addresses

Primary practice location

4640 Lipscomb St NE Ste 4
Palm Bay, FL 32905-2986

Mailing address

4640 Lipscomb St NE Ste 4
Palm Bay, FL 32905-2986
Phone (321) 537-4467

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1638921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638921600000",
    "number": "1023777935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4640 LIPSCOMB ST NE STE 4",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329052986",
            "telephone_number": "321-537-4467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4640 LIPSCOMB ST NE STE 4",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329052986",
            "telephone_number": "321-537-4467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE IRIS BEHAVIORAL SERVICES CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-08",
        "last_updated": "2021-12-08",
        "certification_date": "2021-12-08",
        "status": "A",
        "authorized_official_last_name": "POLANCO",
        "authorized_official_first_name": "DILIANA",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "321-537-4467",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palm Bay, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.