Provider Demographics
NPI:1235467853
Name:LEARY, ABIGAIL W (LCPC)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:W
Last Name:LEARY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 LINCOLN ST STE C
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-1900
Mailing Address - Country:US
Mailing Address - Phone:603-883-0005
Mailing Address - Fax:
Practice Address - Street 1:2364 HARPSWELL ISLANDS RD
Practice Address - Street 2:
Practice Address - City:BAILEY ISLAND
Practice Address - State:ME
Practice Address - Zip Code:04003-2654
Practice Address - Country:US
Practice Address - Phone:207-756-3112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-19
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL3199101YM0800X
MECC3461101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health