Healthcare Provider Details

I. General information

NPI: 1972784460
Provider Name (Legal Business Name): ELEANOR MAE GLEASON PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2007
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 MARKET STREET BEWLEY BUILDING, SUITE 402
LOCKPORT NY
14094-1854
US

IV. Provider business mailing address

6529 HATTER RD
NEWFANE NY
14108-9767
US

V. Phone/Fax

Practice location:
  • Phone: 716-727-9271
  • Fax:
Mailing address:
  • Phone: 716-479-3113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number407128
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number690068
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number019741
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: