Healthcare Provider Details

I. General information

NPI: 1396079604
Provider Name (Legal Business Name): JAMES L MELLO LADC, CCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2009
Last Update Date: 09/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 CONGRESS ST
RUMFORD ME
04276-2092
US

IV. Provider business mailing address

28 CONGRESS ST
RUMFORD ME
04276-2092
US

V. Phone/Fax

Practice location:
  • Phone: 207-364-7006
  • Fax: 207-364-7007
Mailing address:
  • Phone: 207-364-7006
  • Fax: 207-364-7007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLC1673
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCCS2848
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: