Provider Demographics
NPI:1396079604
Name:MELLO, JAMES L (LADC, CCS)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:MELLO
Suffix:
Gender:M
Credentials:LADC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:RUMFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04276-2092
Mailing Address - Country:US
Mailing Address - Phone:207-364-7006
Mailing Address - Fax:207-364-7007
Practice Address - Street 1:28 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:RUMFORD
Practice Address - State:ME
Practice Address - Zip Code:04276-2092
Practice Address - Country:US
Practice Address - Phone:207-364-7006
Practice Address - Fax:207-364-7007
Is Sole Proprietor?:No
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC1673101YA0400X
MECCS2848101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431878099OtherMAINECARE