Healthcare Provider Details

I. General information

NPI: 1912408295
Provider Name (Legal Business Name): KRISTEN GLEASON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2018
Last Update Date: 02/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 ALEXANDER ST STE 5000
ROCHESTER NY
14607-4064
US

IV. Provider business mailing address

222 ALEXANDER ST STE 5000
ROCHESTER NY
14607-4064
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-8003
  • Fax: 585-922-8195
Mailing address:
  • Phone: 585-922-8003
  • Fax: 585-922-8195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number081192
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: