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General NPI Number Information
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NPI Number | 1871875690
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Entity Type | Individual
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Provider Name | TAMARA B MELLO LCPC-C
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Gender | Female
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Dates
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Enumeration Date | 09/19/2011
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Last Update Date | 01/28/2015
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Provider Practice Location Address
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Address Line | 2 SCHOOL ST SUITE 1
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City | WATERVILLE
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State | ME
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Zip | 04901-7518
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Country | US
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Telephone | 207-458-7491
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Fax | 207-274-2999
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Provider Business Mailing Address
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Address Line | 2 SCHOOL ST SUITE 1
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City | WATERVILLE
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State | ME
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Zip | 04901-7518
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Country | US
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Telephone | 207-458-7491
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Fax | 207-274-2999
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | XL3849
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License Number State | ME
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