Provider Demographics
NPI:1407462708
Name:MCGEARY, KAYLEE SHEA
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:SHEA
Last Name:MCGEARY
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 1:2851 FALLS RD
Mailing Address - Street 2:
Mailing Address - City:FALLS
Mailing Address - State:PA
Mailing Address - Zip Code:18615-7732
Mailing Address - Country:US
Mailing Address - Phone:570-290-1398
Mailing Address - Fax:
Practice Address - Street 1:1081 OAK ST STE 3
Practice Address - Street 2:
Practice Address - City:INKERMAN
Practice Address - State:PA
Practice Address - Zip Code:18640-3716
Practice Address - Country:US
Practice Address - Phone:570-802-3099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician