Provider Demographics
NPI:1720169857
Name:JOSIAH GEAUMONT, MELINDA (LCSW)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:JOSIAH GEAUMONT
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 1:6 AUBURN STREET
Mailing Address - Street 2:MELINDA JOSIAH GEAUMONT, LCSW
Mailing Address - City:SPRINGVALE
Mailing Address - State:ME
Mailing Address - Zip Code:04083
Mailing Address - Country:US
Mailing Address - Phone:207-651-8703
Mailing Address - Fax:
Practice Address - Street 1:62 PORTLAND RD, POST ROAD CENTER SUITE #6
Practice Address - Street 2:MELINDA JOSIAH GEAUMONT, LCSW
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043
Practice Address - Country:US
Practice Address - Phone:207-651-8703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC68401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME00135801Medicare PIN