Provider Demographics
NPI:1477018331
Name:POLANCO, DILIANA (LCSW)
Entity Type:Individual
Prefix:
First Name:DILIANA
Middle Name:
Last Name:POLANCO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4640 LIPSCOMB ST NE STE 5
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-2986
Mailing Address - Country:US
Mailing Address - Phone:786-322-3783
Mailing Address - Fax:
Practice Address - Street 1:4640 LIPSCOMB ST NE STE 5
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-2986
Practice Address - Country:US
Practice Address - Phone:321-343-6773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-05
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW158411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical