Provider Demographics
NPI:1922875053
Name:O'LEARY, NICOLE WALKER (LSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:WALKER
Last Name:O'LEARY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 E WASHINGTON ST APT 2
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-2842
Mailing Address - Country:US
Mailing Address - Phone:270-564-3941
Mailing Address - Fax:
Practice Address - Street 1:142 W MARKET ST
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-2930
Practice Address - Country:US
Practice Address - Phone:270-564-3941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW136127104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker