Healthcare Provider Details

I. General information

NPI: 1538998711
Provider Name (Legal Business Name): JENNA GLEASON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 FEDERAL RD STE D22
BROOKFIELD CT
06804-2650
US

IV. Provider business mailing address

PO BOX 38
KENT CT
06757-0038
US

V. Phone/Fax

Practice location:
  • Phone: 203-529-8451
  • Fax:
Mailing address:
  • Phone: 860-488-0323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number46.010017
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7317
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: