Provider Demographics
NPI:1124147863
Name:O'LEARY, BERNADETTE ARLENE (PSYD)
Entity type:Individual
Prefix:DR
First Name:BERNADETTE
Middle Name:ARLENE
Last Name:O'LEARY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6709 LA TIJERA BLVD
Mailing Address - Street 2:SUITE 416
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-2017
Mailing Address - Country:US
Mailing Address - Phone:310-562-5297
Mailing Address - Fax:310-673-6256
Practice Address - Street 1:6709 LA TIJERA BLVD
Practice Address - Street 2:SUITE 416
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-2017
Practice Address - Country:US
Practice Address - Phone:310-562-5297
Practice Address - Fax:310-673-6256
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25036103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical