Provider Demographics
NPI:1225629322
Name:NICHOLE LEARY, LICSW, LLC
Entity Type:Organization
Organization Name:NICHOLE LEARY, LICSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEARY
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:508-958-2358
Mailing Address - Street 1:66 BLACKBERRY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02760-3504
Mailing Address - Country:US
Mailing Address - Phone:508-409-9821
Mailing Address - Fax:
Practice Address - Street 1:500 E WASHINGTON ST UNIT 73
Practice Address - Street 2:
Practice Address - City:NORTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02760-6324
Practice Address - Country:US
Practice Address - Phone:508-409-9821
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty