Provider Demographics
NPI:1073969333
Name:LEARY, CARROLYN PATTERSON
Entity Type:Individual
Prefix:
First Name:CARROLYN
Middle Name:PATTERSON
Last Name:LEARY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 IVY DR
Mailing Address - Street 2:
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563-4337
Mailing Address - Country:US
Mailing Address - Phone:925-768-1968
Mailing Address - Fax:
Practice Address - Street 1:188 IVY DR
Practice Address - Street 2:
Practice Address - City:ORINDA
Practice Address - State:CA
Practice Address - Zip Code:94563-4337
Practice Address - Country:US
Practice Address - Phone:925-768-1968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT47069106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist