Provider Demographics
NPI:1255411567
Name:PLEAU, GARY (LCSW)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:
Last Name:PLEAU
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 MAIN ST STE 204
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-2432
Mailing Address - Country:US
Mailing Address - Phone:207-283-8900
Mailing Address - Fax:207-283-8900
Practice Address - Street 1:275 MAIN ST STE 204
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-2432
Practice Address - Country:US
Practice Address - Phone:207-283-8900
Practice Address - Fax:207-283-8900
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC10739101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431877499Medicaid