Provider Demographics
NPI:1942292354
Name:O'LEARY, JOHN FRANCIS (PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:FRANCIS
Last Name:O'LEARY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25600 WOODWARD AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-0943
Mailing Address - Country:US
Mailing Address - Phone:248-542-8421
Mailing Address - Fax:248-543-5719
Practice Address - Street 1:25600 WOODWARD AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-0943
Practice Address - Country:US
Practice Address - Phone:248-542-8421
Practice Address - Fax:248-543-5719
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301003315103TC0700X, 103G00000X
MI680F328500103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI680F356940OtherBCBS MI
MI680F356940OtherBCBS MI