Individual
MARY LELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MAC, LAC
Contact information
Practice address
535 OCEAN AVE, PORTLAND, ME 04103-4973
(207) 761-7228
Mailing address
535 OCEAN AVE, PORTLAND, ME 04103-4973
(207) 761-7228
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
AC 166
ME
Other
Enumeration date
11/04/2006
Last updated
07/08/2007
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