Provider Demographics
NPI:1598951667
Name:O'LEARY, MARY H (LCSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:H
Last Name:O'LEARY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 PINE ST STE 1B
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-5381
Mailing Address - Country:US
Mailing Address - Phone:716-720-0703
Mailing Address - Fax:
Practice Address - Street 1:500 PINE ST STE 1B
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-5381
Practice Address - Country:US
Practice Address - Phone:716-720-0703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00635098Medicaid