Healthcare Provider Details

I. General information

NPI: 1801296785
Provider Name (Legal Business Name): KATHERINE O'LEARY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2014
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 BAYVIEW AVE STE 4G
STONINGTON CT
06378-1142
US

IV. Provider business mailing address

22 BAYVIEW AVE STE 4G 4G
MYSTIC CT
06355-2302
US

V. Phone/Fax

Practice location:
  • Phone: 860-690-7048
  • Fax:
Mailing address:
  • Phone: 860-690-7048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: