Provider Demographics
NPI:1215305677
Name:BROWN, MELANIE SOSINSKI
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:SOSINSKI
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:RENE
Other - Last Name:SOSINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:510 MAIN STREET
Mailing Address - Street 2:BOX 16
Mailing Address - City:GORHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04038-1339
Mailing Address - Country:US
Mailing Address - Phone:207-318-5650
Mailing Address - Fax:
Practice Address - Street 1:510 MAIN ST OFC 206
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-1339
Practice Address - Country:US
Practice Address - Phone:207-318-5650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-02
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC6109101YA0400X
MELC165701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)