Provider Demographics
NPI:1962520916
Name:LEARY, TIMOTHY J (MSW)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:J
Last Name:LEARY
Suffix:
Gender:M
Credentials:MSW
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 9233
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66201-1833
Mailing Address - Country:US
Mailing Address - Phone:913-205-7049
Mailing Address - Fax:913-341-8125
Practice Address - Street 1:10551 BARKLEY ST STE 512
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-1813
Practice Address - Country:US
Practice Address - Phone:913-205-7049
Practice Address - Fax:913-317-8193
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLSCSW 15321041C0700X
MOLCSW 00042471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical