Healthcare Provider Details

I. General information

NPI: 1619778180
Provider Name (Legal Business Name): JILL R LEARY LICSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2025
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 TURNPIKE RD APT 4402
CHELMSFORD MA
01824-3586
US

IV. Provider business mailing address

104 TURNPIKE RD APT 4402
CHELMSFORD MA
01824-3586
US

V. Phone/Fax

Practice location:
  • Phone: 617-823-5080
  • Fax:
Mailing address:
  • Phone: 617-823-5080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JILL RAE LEARY
Title or Position: OWNER/CLINICAL THERAPIST
Credential: LICSW
Phone: 617-823-5080