Provider Demographics
NPI:1780159640
Name:GLEASON, ANN ELIZABETH II
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:ELIZABETH
Last Name:GLEASON
Suffix:II
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4861 SHELL STREAM BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-4438
Mailing Address - Country:US
Mailing Address - Phone:404-316-7818
Mailing Address - Fax:
Practice Address - Street 1:8022 OLD COUNTY ROAD 54
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-6409
Practice Address - Country:US
Practice Address - Phone:727-784-8244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12658101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health