| Doctor Name: | MELISSA IANNACONE |
| NPI Number: | 1225172844 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LMSWCC |
| License Number: | MC10915 |
| Business Practice Address: | 453 Us Route 1 Kittery, ME - 039045513 |
| Business Phone Number: | 2074398391 |
| Business Fax Number: | 2072827509 |
| Mailing Address: | 453 Us Route 1, KITTERY |
| State: | ME |
| Postal Code: | 03801 |
| Phone Number: | 2074398391 |
| Fax Number: | 2072827509 |
| NPI Enumeration Date: | 02/16/2007 |
| NPI Last Update Date: | 07/16/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | MC10915 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ME |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |