MEDICARE: MR. JOHN ROBERT GLEASON MS, LCMHC, LADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	000358	VT
2	101YM0800X	Mental Health Counselor	0680000566	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295744654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN ROBERT GLEASON MS, LCMHC, LADC

Provider Business Mailing Address
First Line	:	187 SAINT PAUL ST
Second Line	:
City	:	BURLINGTON
State	:	VT
Zip	:	05401-4689
Country	:	US
Telephone Number	:	802-865-0534
Fax Number	:	802-865-0534

Provider Business Practice Location Address
First Line	:	187 SAINT PAUL ST
Second Line	:
City	:	BURLINGTON
State	:	VT
Zip	:	05401-4689
Country	:	US
Telephone Number	:	802-865-0534
Fax Number	:	802-865-0534

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	09/11/2025

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