Provider Demographics
NPI:1316627540
Name:O'LEARY, DAVID FRANCIS
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:FRANCIS
Last Name:O'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:PO BOX 8038
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:VT
Mailing Address - Zip Code:05451-8038
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55 MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:ESSEX JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05452-6100
Practice Address - Country:US
Practice Address - Phone:802-391-6680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-21
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT047.0133705101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health