MEDICARE: POLYCARPE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	MH 6651	FL

General Provider Information

NPI Number	:	1780904326
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POLYCARPE, INC.

Provider Business Mailing Address
First Line	:	121 S ORANGE AVE
Second Line	:	SUITE 1500
City	:	ORLANDO
State	:	FL
Zip	:	32801-3221
Country	:	US
Telephone Number	:	407-792-5896
Fax Number	:

Provider Business Practice Location Address
First Line	:	121 S ORANGE AVE
Second Line	:	SUITE 1500
City	:	ORLANDO
State	:	FL
Zip	:	32801-3221
Country	:	US
Telephone Number	:	407-792-5896
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. PENNY B DELERME
Credential	:	LMHC
Telephone Number	:	407-792-5896

Provider Enumeration Date	:	06/06/2010
Last Update Date	:	10/16/2014

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Directions to “POLYCARPE, INC. ” Practice Location

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