Provider Demographics
NPI:1710185129
Name:GLEASON, MAREN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MAREN
Middle Name:
Last Name:GLEASON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 SAN RAMON VALLEY BLVD STE 4241
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-5381
Mailing Address - Country:US
Mailing Address - Phone:925-838-2375
Mailing Address - Fax:
Practice Address - Street 1:2010 CROW CANYON PL STE 100
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1344
Practice Address - Country:US
Practice Address - Phone:925-838-2375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2020-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA234061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical