Provider Demographics
NPI:1265245401
Name:LEARY, KATHRYN GRACE (MA, AMFT)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:GRACE
Last Name:LEARY
Suffix:
Gender:F
Credentials:MA, AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2503 STUART ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1208
Mailing Address - Country:US
Mailing Address - Phone:707-364-3091
Mailing Address - Fax:
Practice Address - Street 1:2503 STUART ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1208
Practice Address - Country:US
Practice Address - Phone:707-364-3091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT150282106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist