Provider Demographics
NPI:1316124464
Name:PLEAU, GARY MICHAEL
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:MICHAEL
Last Name:PLEAU
Suffix:
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 1:25 POOL ST
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-2877
Mailing Address - Country:US
Mailing Address - Phone:207-283-8032
Mailing Address - Fax:207-283-4248
Practice Address - Street 1:25 POOL ST
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-2877
Practice Address - Country:US
Practice Address - Phone:207-283-8032
Practice Address - Fax:207-283-4248
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC3315101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME104318Medicaid