Provider Demographics
NPI:1225122526
Name:GLEASON, JOAN DOROTHY (MS, LADC, LPC)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:DOROTHY
Last Name:GLEASON
Suffix:
Gender:F
Credentials:MS, LADC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-5207
Mailing Address - Country:US
Mailing Address - Phone:860-645-8514
Mailing Address - Fax:860-432-2684
Practice Address - Street 1:223 E CENTER ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-5207
Practice Address - Country:US
Practice Address - Phone:860-645-8514
Practice Address - Fax:860-432-2684
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000123101YA0400X
CT000328101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional