Provider Demographics
NPI:1497992028
Name:MELE, GEORGE WESLEY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:WESLEY
Last Name:MELE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 TILLSON AVE
Mailing Address - Street 2:SUITE 214
Mailing Address - City:ROCKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04841-3451
Mailing Address - Country:US
Mailing Address - Phone:207-701-1647
Mailing Address - Fax:207-354-4015
Practice Address - Street 1:120 TILLSON AVE
Practice Address - Street 2:SUITE 214
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841-3344
Practice Address - Country:US
Practice Address - Phone:207-701-1647
Practice Address - Fax:207-354-4015
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-20
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC15541101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1447992028Medicare NSC
ME1477992028Medicare NSC