Healthcare Provider Details

I. General information

NPI: 1275468522
Provider Name (Legal Business Name): JESSICA MELLON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 CUMBERLAND ST STE B
BRUNSWICK ME
04011-2162
US

IV. Provider business mailing address

6 CUMBERLAND ST STE B
BRUNSWICK ME
04011-2162
US

V. Phone/Fax

Practice location:
  • Phone: 207-613-1939
  • Fax:
Mailing address:
  • Phone: 207-613-1939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: JESSICA MELLON
Title or Position: OWNER AND LICENSED THERAPIST
Credential: LCPC
Phone: 207-613-1939