Basic Information
| Provider Information | |||||||||
| NPI: | 1386966158 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MACE | ||||||||
| FirstName: | MELANIE | ||||||||
| MiddleName: | ANASTASIA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 43 HATCH DRIVE | ||||||||
| Address2: | PO BOX 1018 | ||||||||
| City: | CARIBOU | ||||||||
| State: | ME | ||||||||
| PostalCode: | 047365439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074986431 | ||||||||
| FaxNumber: | 2074923181 | ||||||||
| Practice Location | |||||||||
| Address1: | 14 STEVE'S LANE | ||||||||
| Address2: | |||||||||
| City: | MARSHFIELD | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2072550996 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2010 | ||||||||
| LastUpdateDate: | 02/25/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PS1319 | ME | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 1386966158 | 05 | ME | MEDICAID |