Healthcare Provider Details

I. General information

NPI: 1831442839
Provider Name (Legal Business Name): MELISSA MARY PARKER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA MARY PARKER LCSW

II. Dates (important events)

Enumeration Date: 10/16/2012
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MARKET ST STE 205
SCARBOROUGH ME
04074-7683
US

IV. Provider business mailing address

901 WASHINGTON AVE STE 100
PORTLAND ME
04103-2842
US

V. Phone/Fax

Practice location:
  • Phone: 207-503-3583
  • Fax:
Mailing address:
  • Phone: 207-871-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC15010
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberMC13812
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: