Provider Demographics
NPI:1326849183
Name:O'LEARY, PETER PAUL
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:PAUL
Last Name:O'LEARY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54B LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-3156
Mailing Address - Country:US
Mailing Address - Phone:802-595-5204
Mailing Address - Fax:
Practice Address - Street 1:1233 SHELBURNE RD
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-7700
Practice Address - Country:US
Practice Address - Phone:802-595-5204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT097.0134403101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health