Provider Demographics
NPI:1417598616
Name:COLLEARY, MAUREEN S (PHD)
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:S
Last Name:COLLEARY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MAUREEN
Other - Middle Name:S
Other - Last Name:COLLEARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:STANLEY
Mailing Address - Street 1:118 ARUNDEL AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1708
Mailing Address - Country:US
Mailing Address - Phone:860-690-1490
Mailing Address - Fax:
Practice Address - Street 1:609 W JOHNSON AVE STE 104
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-4506
Practice Address - Country:US
Practice Address - Phone:203-272-6007
Practice Address - Fax:203-272-8895
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT01451103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist