Provider Demographics
NPI:1164644027
Name:O'LEARY, TOBY COLTIN (MSW)
Entity Type:Individual
Prefix:MS
First Name:TOBY
Middle Name:COLTIN
Last Name:O'LEARY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 STEVENS CIR
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-1832
Mailing Address - Country:US
Mailing Address - Phone:978-475-0566
Mailing Address - Fax:
Practice Address - Street 1:7 STEVENS CIR
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-1832
Practice Address - Country:US
Practice Address - Phone:978-475-0566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1015420101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health