Provider Demographics
NPI:1285832311
Name:GLEASON, PETER C (PHD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:C
Last Name:GLEASON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 MAYFLOWER WAY
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:ME
Mailing Address - Zip Code:04364-4106
Mailing Address - Country:US
Mailing Address - Phone:617-512-0472
Mailing Address - Fax:
Practice Address - Street 1:2 BIG SKY LN
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4340
Practice Address - Country:US
Practice Address - Phone:207-872-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1507103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical