=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568934479
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEE ANN O'LEARY LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/18/2018
-----------------------------------------------------
Last Update Date | 03/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 376 MAIN ST STE 300
-----------------------------------------------------
City | BEDMINSTER
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07921-2591
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-300-6808
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 376 MAIN ST STE 300
-----------------------------------------------------
City | BEDMINSTER
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07921-2591
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-300-6808
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 44SC05754700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------