Provider Demographics
NPI:1538287180
Name:PLOURDE, MELANIE (LCSW)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:PLOURDE
Suffix:
Gender:F
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:PO BOX 142
Mailing Address - Street 2:
Mailing Address - City:FORT KENT
Mailing Address - State:ME
Mailing Address - Zip Code:04743-0142
Mailing Address - Country:US
Mailing Address - Phone:207-231-4542
Mailing Address - Fax:207-728-3131
Practice Address - Street 1:272 W MAIN ST APT 105
Practice Address - Street 2:
Practice Address - City:FORT KENT
Practice Address - State:ME
Practice Address - Zip Code:04743-1282
Practice Address - Country:US
Practice Address - Phone:207-231-4542
Practice Address - Fax:207-728-3131
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC117641041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1538287180OtherMAINE CARE
ME770401Medicare PIN