Provider Demographics
NPI:1871384693
Name:O'LEARY, CECILY SHANNON (LCSW)
Entity type:Individual
Prefix:MS
First Name:CECILY
Middle Name:SHANNON
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 1:55 N SHORE DR UNIT 2
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-2905
Mailing Address - Country:US
Mailing Address - Phone:978-257-3927
Mailing Address - Fax:
Practice Address - Street 1:1045 WARWICK AVE STE 101
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-3657
Practice Address - Country:US
Practice Address - Phone:401-480-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALCSW2310541041C0700X
RICSW039581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALCSW231054OtherTHE COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
MAS56519908OtherMASSACHUSETTS DEPARTMENT OF MOTOR VEHICLES
RICSW03958OtherRHODE ISLAND DEPARTMENT OF HEALTH