Provider Demographics
NPI:1386823839
Name:LEARY, NANCY J (LICSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:J
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 1:106 STATE ROAD
Mailing Address - Street 2:
Mailing Address - City:NORTH DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-2923
Mailing Address - Country:US
Mailing Address - Phone:508-642-2389
Mailing Address - Fax:508-342-5669
Practice Address - Street 1:106 STATE ROAD
Practice Address - Street 2:
Practice Address - City:NORTH DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-2923
Practice Address - Country:US
Practice Address - Phone:508-642-2389
Practice Address - Fax:508-342-5669
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2119411041C0700X
MA4005301041S0200X
MA1150731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool