Provider Demographics
NPI:1386966158
Name:MACE, MELANIE ANASTASIA (PSYD)
Entity type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:ANASTASIA
Last Name:MACE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 HATCH DRIVE
Mailing Address - Street 2:PO BOX 1018
Mailing Address - City:CARIBOU
Mailing Address - State:ME
Mailing Address - Zip Code:04736-5439
Mailing Address - Country:US
Mailing Address - Phone:207-498-6431
Mailing Address - Fax:207-492-3181
Practice Address - Street 1:14 STEVE'S LANE
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:ME
Practice Address - Zip Code:04654
Practice Address - Country:US
Practice Address - Phone:207-255-0996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-22
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1319103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1386966158Medicaid
ME1811100068Medicare UPIN