Provider Demographics
NPI:1629133897
Name:GLEASON, PATRICK MICHAEL (PHD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:MICHAEL
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 1:725 5TH STREET, NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002
Mailing Address - Country:US
Mailing Address - Phone:202-543-4205
Mailing Address - Fax:202-543-8302
Practice Address - Street 1:236 MASSACHUSETTS AVE NE
Practice Address - Street 2:#409
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-4980
Practice Address - Country:US
Practice Address - Phone:202-543-4205
Practice Address - Fax:202-543-8302
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3018851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical