Provider Demographics
NPI:1306087986
Name:LEARY, JENNIFER ALICIA (MS)
Entity type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:ALICIA
Last Name:LEARY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 NEW SCOTLAND AVE
Mailing Address - Street 2:A
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-1725
Mailing Address - Country:US
Mailing Address - Phone:518-281-1111
Mailing Address - Fax:
Practice Address - Street 1:590 GIFFORDS CHURCH RD
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12306-5313
Practice Address - Country:US
Practice Address - Phone:518-355-0826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool