Healthcare Provider Details

I. General information

NPI: 1841574563
Provider Name (Legal Business Name): ABIGAIL RYAN GLEASON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2011
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 HARRISON ST
SYRACUSE NY
13210-2695
US

IV. Provider business mailing address

689 N CLINTON ST APT 301
SYRACUSE NY
13204-1487
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-3265
  • Fax:
Mailing address:
  • Phone: 315-406-3886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number098920
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: