Healthcare Provider Details

I. General information

NPI: 1720169857
Provider Name (Legal Business Name): MELINDA JOSIAH GEAUMONT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 PORTLAND RD, POST ROAD CENTER SUITE #6 MELINDA JOSIAH GEAUMONT, LCSW
KENNEBUNK ME
04043
US

IV. Provider business mailing address

6 AUBURN STREET MELINDA JOSIAH GEAUMONT, LCSW
SPRINGVALE ME
04083
US

V. Phone/Fax

Practice location:
  • Phone: 207-651-8703
  • Fax:
Mailing address:
  • Phone: 207-651-8703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC6840
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: