Healthcare Provider Details

I. General information

NPI: 1962812719
Provider Name (Legal Business Name): KATIE NEARY MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2014
Last Update Date: 05/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 S 9TH ST
LEBANON PA
17042-5104
US

IV. Provider business mailing address

105 STONY RUN WAY
YORK PA
17406-6108
US

V. Phone/Fax

Practice location:
  • Phone: 717-273-5992
  • Fax: 717-273-5995
Mailing address:
  • Phone: 717-273-5992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberBH001677
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: