Provider Demographics
NPI:1134456957
Name:CHMELECKI, MICHELLE T (PMHNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:T
Last Name:CHMELECKI
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:CHMELECKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PMHNP
Mailing Address - Street 1:225 COMMERCIAL ST STE 302
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-6606
Mailing Address - Country:US
Mailing Address - Phone:207-470-0569
Mailing Address - Fax:207-470-0570
Practice Address - Street 1:225 COMMERCIAL ST STE 302
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-6606
Practice Address - Country:US
Practice Address - Phone:207-470-0569
Practice Address - Fax:207-470-0570
Is Sole Proprietor?:No
Enumeration Date:2009-11-16
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECMP91060363LP0808X
MEAP091060363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health