Provider Demographics
NPI:1487716098
Name:MELDRUM, BRIAN M (LCPC)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:M
Last Name:MELDRUM
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 LEADBETTER RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:ME
Mailing Address - Zip Code:04284
Mailing Address - Country:US
Mailing Address - Phone:207-783-2665
Mailing Address - Fax:207-685-8113
Practice Address - Street 1:1 WAKEFIELD ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240
Practice Address - Country:US
Practice Address - Phone:207-783-2665
Practice Address - Fax:207-685-4090
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC769101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME047378OtherANTHEM BCBS