Provider Demographics
NPI:1902634413
Name:LEARY, JENELLE (MED, LMHCA)
Entity type:Individual
Prefix:
First Name:JENELLE
Middle Name:
Last Name:LEARY
Suffix:
Gender:F
Credentials:MED, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:MA
Mailing Address - Zip Code:02370-1714
Mailing Address - Country:US
Mailing Address - Phone:617-869-6319
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 472
Practice Address - Street 2:
Practice Address - City:WHEATLAND
Practice Address - State:WY
Practice Address - Zip Code:82201-0472
Practice Address - Country:US
Practice Address - Phone:307-331-7869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61554267101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health