MEDICARE: TERRENCE J NEARY PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	071-003543	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	05619771	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1477552685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRENCE J NEARY PHD

Provider Business Mailing Address
First Line	:	145 S VIRGINIA ST
Second Line	:
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-7226
Country	:	US
Telephone Number	:	815-444-9999
Fax Number	:	815-986-1363

Provider Business Practice Location Address
First Line	:	970 MCHENRY AVE
Second Line	:
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-7449
Country	:	US
Telephone Number	:	815-455-7100
Fax Number	:	815-455-3951

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	04/20/2016

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Directions to “ TERRENCE J NEARY PHD” Practice Location

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