Provider Demographics
NPI:1528359338
Name:LEARY, PAMELA PHILBROOK (MA, MS, LCPC-C)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:PHILBROOK
Last Name:LEARY
Suffix:
Gender:F
Credentials:MA, MS, LCPC-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1120 CENTER ST
Mailing Address - Street 2:SUITE 308
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-6528
Mailing Address - Country:US
Mailing Address - Phone:207-333-3375
Mailing Address - Fax:207-333-3380
Practice Address - Street 1:1120 CENTER ST
Practice Address - Street 2:SUITE 308
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-6528
Practice Address - Country:US
Practice Address - Phone:207-333-3375
Practice Address - Fax:207-333-3380
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MEXL3768101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health