Provider Demographics
NPI:1992147508
Name:GEARY, TERRY
Entity type:Individual
Prefix:MR
First Name:TERRY
Middle Name:
Last Name:GEARY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 WOODHAVEN ST
Mailing Address - Street 2:
Mailing Address - City:CARVER
Mailing Address - State:MA
Mailing Address - Zip Code:02330-1385
Mailing Address - Country:US
Mailing Address - Phone:508-866-3269
Mailing Address - Fax:
Practice Address - Street 1:50 WOODHAVEN ST
Practice Address - Street 2:
Practice Address - City:CARVER
Practice Address - State:MA
Practice Address - Zip Code:02330-1385
Practice Address - Country:US
Practice Address - Phone:508-866-3269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA023582101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health