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General NPI Number Information
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NPI Number | 1154867877
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Entity Type | Individual
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Provider Name | ALEXANDRA GLEASON LMFT
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Gender | Female
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Dates
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Enumeration Date | 01/19/2017
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Last Update Date | 01/19/2017
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Provider Practice Location Address
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Address Line | 15 DAVE LN
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City | SOUTH SETAUKET
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State | NY
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Zip | 11720-1006
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Country | US
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Telephone | 516-993-6678
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Fax |
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Provider Business Mailing Address
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Address Line | 3771 NESCONSET HWY STE 214
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City | SOUTH SETAUKET
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State | NY
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Zip | 11720-1163
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Country | US
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Telephone | 516-993-6678
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 001311
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License Number State | NY
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