Healthcare Provider Details

I. General information

NPI: 1710458385
Provider Name (Legal Business Name): CHELSEA GLEASON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2018
Last Update Date: 12/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1734 MARYLAND AVE STE 200
BALTIMORE MD
21201-5804
US

IV. Provider business mailing address

1721 GUILFORD AVE APT 3
BALTIMORE MD
21202-5452
US

V. Phone/Fax

Practice location:
  • Phone: 877-674-2843
  • Fax:
Mailing address:
  • Phone: 914-772-4381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number23773
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: