Healthcare Provider Details

I. General information

NPI: 1821691981
Provider Name (Legal Business Name): MELISSA O'CONNOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA JACQUES

II. Dates (important events)

Enumeration Date: 11/19/2020
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 PORTLAND RD
ARUNDEL ME
04046-7950
US

IV. Provider business mailing address

254 COMMERCIAL ST STE 245
PORTLAND ME
04101-4899
US

V. Phone/Fax

Practice location:
  • Phone: 207-292-5891
  • Fax:
Mailing address:
  • Phone: 404-400-5004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: