Provider Demographics
NPI:1720428550
Name:O'LEARY, MAUREEN KAY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:KAY
Last Name:O'LEARY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 2ND ST S
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-3944
Mailing Address - Country:US
Mailing Address - Phone:208-463-0202
Mailing Address - Fax:208-463-0205
Practice Address - Street 1:1305 2ND ST S
Practice Address - Street 2:SUITE 201
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-3944
Practice Address - Country:US
Practice Address - Phone:208-463-0202
Practice Address - Fax:208-463-0205
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW 281101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical