Provider Demographics
NPI:1417969262
Name:LEARY, CATHY (PH D)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:LEARY
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7744 BROADWAY ST
Mailing Address - Street 2:STE. 105
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-3225
Mailing Address - Country:US
Mailing Address - Phone:210-821-3365
Mailing Address - Fax:210-822-7542
Practice Address - Street 1:7744 BROADWAY ST
Practice Address - Street 2:STE. 105
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-3225
Practice Address - Country:US
Practice Address - Phone:210-821-3365
Practice Address - Fax:210-822-7542
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21635103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00FJ92OtherBLUE CROSS BLUE SHIELD