Provider Demographics
NPI:1447629423
Name:BROWN, MELISSA BETH (LCPC-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:BETH
Last Name:BROWN
Suffix:
Gender:F
Credentials:LCPC-C
Other - Prefix:
Other - First Name:MEL
Other - Middle Name:B
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC-C
Mailing Address - Street 1:9 CLEVELAND ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-5407
Mailing Address - Country:US
Mailing Address - Phone:207-712-4510
Mailing Address - Fax:
Practice Address - Street 1:39 MECHANIC ST
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-2855
Practice Address - Country:US
Practice Address - Phone:207-712-4510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-19
Last Update Date:2015-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME#XL4429101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health