Provider Demographics
NPI:1003301508
Name:LEARY, NORA MARY (LICSW)
Entity Type:Individual
Prefix:
First Name:NORA
Middle Name:MARY
Last Name:LEARY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 LYMAN RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-4637
Mailing Address - Country:US
Mailing Address - Phone:617-293-5154
Mailing Address - Fax:
Practice Address - Street 1:110 LYMAN RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-4637
Practice Address - Country:US
Practice Address - Phone:617-293-5154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MA10259581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical