Provider Demographics
NPI:1104075613
Name:LEARY, KERRY B (MED)
Entity type:Individual
Prefix:MS
First Name:KERRY
Middle Name:B
Last Name:LEARY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26
Mailing Address - Street 2:
Mailing Address - City:CARVER
Mailing Address - State:MA
Mailing Address - Zip Code:02330-0026
Mailing Address - Country:US
Mailing Address - Phone:508-866-5408
Mailing Address - Fax:
Practice Address - Street 1:225 WATER ST
Practice Address - Street 2:SUITE B-236
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4060
Practice Address - Country:US
Practice Address - Phone:508-747-6302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health