Healthcare Provider Details

I. General information

NPI: 1053687442
Provider Name (Legal Business Name): MELISSA LEE ORTEGA PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 BRACKETT POINT RD
BIDDEFORD ME
04005-9236
US

IV. Provider business mailing address

3 BRACKETT POINT RD
BIDDEFORD ME
04005-9236
US

V. Phone/Fax

Practice location:
  • Phone: 207-710-8761
  • Fax: 207-710-8761
Mailing address:
  • Phone: 207-710-8761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number019466
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPS2496
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPS2496
License Number StateME
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS2496
License Number StateME
# 5
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number019466
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number019466
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: