Healthcare Provider Details

I. General information

NPI: 1992938468
Provider Name (Legal Business Name): MELISSA JANE ANDERSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2009
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 RAYMOND HILL RD
RAYMOND ME
04071-6142
US

IV. Provider business mailing address

152 RAYMOND HILL RD
RAYMOND ME
04071-6142
US

V. Phone/Fax

Practice location:
  • Phone: 207-838-2077
  • Fax:
Mailing address:
  • Phone: 207-838-2077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC 8213
License Number StateME

VII. Legacy identifiers

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

# 1
Identifier434467200
Identifier TypeOTHER
Identifier StateME
Identifier IssuerMAINECARE SERVICES

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: