Individual
RANDALL R MELVIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW BCD
Contact information
Practice address
465 CONGRESS ST, SUITE 700, PORTLAND, ME 04101-3528
(207) 773-2828
(207) 761-8150
Mailing address
465 CONGRESS ST, SUITE 700, PORTLAND, ME 04101-3528
(207) 773-2828
(207) 761-8150
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC4787
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
040317
ANTHEM BLUE CROSS
ME
Enumeration date
07/26/2006
Last updated
07/08/2008
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