Provider Demographics
NPI:1699904425
Name:O'LEARY, DOROTHY (MFT)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:O'LEARY
Suffix:
Gender:F
Credentials:MFT
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 335
Mailing Address - Street 2:
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94976-0335
Mailing Address - Country:US
Mailing Address - Phone:415-339-7440
Mailing Address - Fax:
Practice Address - Street 1:1414 4TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2857
Practice Address - Country:US
Practice Address - Phone:415-339-7440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT52594101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health