Provider Demographics
NPI:1417605510
Name:TENNEY, MELISSA L
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:L
Last Name:TENNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 OTIS RD
Mailing Address - Street 2:
Mailing Address - City:OTIS
Mailing Address - State:ME
Mailing Address - Zip Code:04605-6703
Mailing Address - Country:US
Mailing Address - Phone:207-537-2203
Mailing Address - Fax:
Practice Address - Street 1:105 OTIS RD
Practice Address - Street 2:
Practice Address - City:OTIS
Practice Address - State:ME
Practice Address - Zip Code:04605-6703
Practice Address - Country:US
Practice Address - Phone:207-537-2203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty