Healthcare Provider Details

I. General information

NPI: 1306087986
Provider Name (Legal Business Name): JENNIFER ALICIA LEARY MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2009
Last Update Date: 03/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 GIFFORDS CHURCH RD
SCHENECTADY NY
12306-5313
US

IV. Provider business mailing address

715 NEW SCOTLAND AVE A
ALBANY NY
12208-1725
US

V. Phone/Fax

Practice location:
  • Phone: 518-355-0826
  • Fax:
Mailing address:
  • Phone: 518-281-1111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: