Provider Demographics
NPI:1780904326
Name:POLYCARPE, INC.
Entity type:Organization
Organization Name:POLYCARPE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:B
Authorized Official - Last Name:DELERME
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:407-792-5896
Mailing Address - Street 1:121 S ORANGE AVE
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-3221
Mailing Address - Country:US
Mailing Address - Phone:407-792-5896
Mailing Address - Fax:
Practice Address - Street 1:121 S ORANGE AVE
Practice Address - Street 2:SUITE 1500
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-3221
Practice Address - Country:US
Practice Address - Phone:407-792-5896
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-06
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 6651251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health