Provider Demographics
NPI:1386828432
Name:GLEASON, MARTHA ELIZABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:ELIZABETH
Last Name:GLEASON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950-4264
Mailing Address - Country:US
Mailing Address - Phone:831-375-0728
Mailing Address - Fax:831-375-0728
Practice Address - Street 1:621 FOREST AVE
Practice Address - Street 2:
Practice Address - City:PACIFIC GROVE
Practice Address - State:CA
Practice Address - Zip Code:93950-4264
Practice Address - Country:US
Practice Address - Phone:831-375-0728
Practice Address - Fax:831-375-0728
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17046103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist