Provider Demographics
NPI:1477380574
Name:ALLEYNE, GLADSTONE SEYMOUR JR
Entity type:Individual
Prefix:MR
First Name:GLADSTONE
Middle Name:SEYMOUR
Last Name:ALLEYNE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CAMERON GROVE BLVD APT 103
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-8632
Mailing Address - Country:US
Mailing Address - Phone:301-452-8348
Mailing Address - Fax:
Practice Address - Street 1:1 CAMERON GROVE BLVD APT 103
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-8632
Practice Address - Country:US
Practice Address - Phone:301-452-8348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-14
Last Update Date:2024-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD108161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical