Healthcare Provider Details

I. General information

NPI: 1922888155
Provider Name (Legal Business Name): SALIX BEHAVIORAL AND WELLNESS SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2023
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2803 MANCINA CT
WEST MELBOURNE FL
32904-5707
US

IV. Provider business mailing address

2803 MANCINA CT
WEST MELBOURNE FL
32904-5707
US

V. Phone/Fax

Practice location:
  • Phone: 321-537-4467
  • Fax:
Mailing address:
  • Phone: 321-209-2262
  • Fax: 321-339-1884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DILIANA B POLANCO
Title or Position: PRESIDENT
Credential: LCSW
Phone: 321-209-1339