Provider Demographics
NPI:1124663687
Name:LEARY, DENIS MICHAEL
Entity type:Individual
Prefix:
First Name:DENIS
Middle Name:MICHAEL
Last Name:LEARY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-3025
Mailing Address - Country:US
Mailing Address - Phone:508-963-3674
Mailing Address - Fax:
Practice Address - Street 1:59 SOUTH ST
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-3025
Practice Address - Country:US
Practice Address - Phone:508-963-3674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-08
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20187131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical