Provider Demographics
NPI:1124478490
Name:GLEASON, MICHAEL D (MS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:GLEASON
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 E LAKE RD UNIT 7C
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-2353
Mailing Address - Country:US
Mailing Address - Phone:315-415-5465
Mailing Address - Fax:
Practice Address - Street 1:235 NORTH AVE
Practice Address - Street 2:
Practice Address - City:PENN YAN
Practice Address - State:NY
Practice Address - Zip Code:14527-1051
Practice Address - Country:US
Practice Address - Phone:315-536-7447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-17
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities