MEDICARE: ALICE E MELLO LADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	LC5945	ME

General Provider Information

NPI Number	:	1033632302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICE E MELLO LADC

Provider Business Mailing Address
First Line	:	268 STATE ST STE 2-3
Second Line	:
City	:	BANGOR
State	:	ME
Zip	:	04401-5417
Country	:	US
Telephone Number	:	207-403-4261
Fax Number	:

Provider Business Practice Location Address
First Line	:	268 STATE ST STE 2-3
Second Line	:
City	:	BANGOR
State	:	ME
Zip	:	04401-5417
Country	:	US
Telephone Number	:	207-403-4261
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2017
Last Update Date	:	07/21/2022

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Directions to “ ALICE E MELLO LADC” Practice Location

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