Provider Demographics
NPI:1093063901
Name:BLANCHETTE, MELISSA M (MHRT-CSP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:M
Last Name:BLANCHETTE
Suffix:
Gender:F
Credentials:MHRT-CSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-2817
Mailing Address - Country:US
Mailing Address - Phone:207-768-3304
Mailing Address - Fax:207-764-6340
Practice Address - Street 1:162 MAIN ST
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-2817
Practice Address - Country:US
Practice Address - Phone:207-768-3304
Practice Address - Fax:207-764-6340
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME103850000Medicaid