Provider Demographics
NPI:1134453723
Name:MILLER, MELANIE D (LCPC-C)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:D
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 COMMERCIAL ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-5964
Mailing Address - Country:US
Mailing Address - Phone:207-470-7090
Mailing Address - Fax:207-470-7094
Practice Address - Street 1:247 COMMERCIAL ST
Practice Address - Street 2:SUITE C
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-5964
Practice Address - Country:US
Practice Address - Phone:207-470-7090
Practice Address - Fax:207-470-7094
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL3570101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional