Provider Demographics
NPI:1720147374
Name:O'LEARY, MARIANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARIANNE
Middle Name:
Last Name:O'LEARY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3355 SAINT JOHNS LN
Mailing Address - Street 2:SUITE F
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-2605
Mailing Address - Country:US
Mailing Address - Phone:410-465-5520
Mailing Address - Fax:410-480-0110
Practice Address - Street 1:3355 SAINT JOHNS LN
Practice Address - Street 2:SUITE F
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-2605
Practice Address - Country:US
Practice Address - Phone:410-465-5520
Practice Address - Fax:410-480-0110
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03270103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD180RMedicare ID - Type Unspecified