Healthcare Provider Details

I. General information

NPI: 1538287180
Provider Name (Legal Business Name): MELANIE PLOURDE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 W MAIN ST APT 105
FORT KENT ME
04743-1282
US

IV. Provider business mailing address

PO BOX 142
FORT KENT ME
04743-0142
US

V. Phone/Fax

Practice location:
  • Phone: 207-231-4542
  • Fax: 207-728-3131
Mailing address:
  • Phone: 207-231-4542
  • Fax: 207-728-3131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC11764
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: