Provider Demographics
NPI:1215107099
Name:LEARY, CHRISTOPHER J (LADC)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:J
Last Name:LEARY
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 ELM ST STE 204
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-3739
Mailing Address - Country:US
Mailing Address - Phone:860-741-3001
Mailing Address - Fax:860-741-8332
Practice Address - Street 1:113 ELM ST STE 204
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-3739
Practice Address - Country:US
Practice Address - Phone:860-741-3001
Practice Address - Fax:860-741-8332
Is Sole Proprietor?:No
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000476101YA0400X
CT000061101YM0800X, 101YP2500X
MA3665101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT301508OtherMANAGED HEALTH NETWORK
CTA412956OtherOXFORD INSURANCE
CTCTGA000477-B001475OtherSTATE ADMINISTER ASST.
CT321137OtherVALUE OPTIONS
CT300000476CT01OtherANTHEM BC/BS