Healthcare Provider Details

I. General information

NPI: 1144473828
Provider Name (Legal Business Name): BRIAN DAVID O'LEARY PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USAHC - VICENZA UNIT 31403, BOX 13
APO AE
09630
US

IV. Provider business mailing address

USAHC - VICENZA UNIT 31403, BOX 13
APO AE
09630
US

V. Phone/Fax

Practice location:
  • Phone: 44-471-7604
  • Fax:
Mailing address:
  • Phone: 44-471-7604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1518
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: