Provider Demographics
NPI:1922103662
Name:BEALE- GLEASON, AMY JEAN (LCSW-R)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JEAN
Last Name:BEALE- GLEASON
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 E ADAMS ST
Mailing Address - Street 2:DEPARTMENT OF PSYCHIATRY
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2306
Mailing Address - Country:US
Mailing Address - Phone:315-464-5267
Mailing Address - Fax:315-464-3202
Practice Address - Street 1:750 E ADAMS ST
Practice Address - Street 2:DEPARTMENT OF PSYCHIATRY
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2306
Practice Address - Country:US
Practice Address - Phone:315-464-5267
Practice Address - Fax:315-464-3202
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0749641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical