Provider Demographics
NPI:1811101868
Name:O'LEARY, TARA E
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:E
Last Name:O'LEARY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 MASSACHUSETTS AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-8448
Mailing Address - Country:US
Mailing Address - Phone:781-641-0089
Mailing Address - Fax:
Practice Address - Street 1:180 MASSACHUSETTS AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-8448
Practice Address - Country:US
Practice Address - Phone:781-641-0089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8440103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical