MEDICARE: GRACE O'LEARY LCSW, MT-BC, CT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCSW-23142	AZ
2	225A00000X	Music Therapist

General Provider Information

NPI Number	:	1659895969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE O'LEARY LCSW, MT-BC, CT

Provider Business Mailing Address
First Line	:	18001 N 79TH AVE STE A10
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-8389
Country	:	US
Telephone Number	:	480-494-9912
Fax Number	:

Provider Business Practice Location Address
First Line	:	18001 N 79TH AVE STE A10
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-8389
Country	:	US
Telephone Number	:	480-494-9912
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2017
Last Update Date	:	03/12/2026

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