Provider Demographics
NPI:1366631541
Name:GLADSTONE, NEIL OLIVER (MS)
Entity Type:Individual
Prefix:MR
First Name:NEIL
Middle Name:OLIVER
Last Name:GLADSTONE
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 ALLEN AVE
Mailing Address - Street 2:
Mailing Address - City:WABAN
Mailing Address - State:MA
Mailing Address - Zip Code:02468-1734
Mailing Address - Country:US
Mailing Address - Phone:617-877-0862
Mailing Address - Fax:
Practice Address - Street 1:185 ALLEN AVE
Practice Address - Street 2:
Practice Address - City:WABAN
Practice Address - State:MA
Practice Address - Zip Code:02468-1734
Practice Address - Country:US
Practice Address - Phone:617-877-0862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1020701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical