Healthcare Provider Details

I. General information

NPI: 1780404061
Provider Name (Legal Business Name): WILLIAM FRANCIS OLEARY LCSW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 JOHNSON AVE STE 50
BOHEMIA NY
11716-2614
US

IV. Provider business mailing address

22 PARSON DR
STONY BROOK NY
11790-2615
US

V. Phone/Fax

Practice location:
  • Phone: 631-921-9138
  • Fax:
Mailing address:
  • Phone: 631-921-9138
  • Fax: 866-581-9296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM OLEARY
Title or Position: OWNER
Credential:
Phone: 631-921-9138