MEDICARE: DR. MARIANNE O'LEARY PH.D.

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	103T00000X	Psychologist	03270	MD

General Provider Information

NPI Number	:	1720147374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIANNE O'LEARY PH.D.

Provider Business Mailing Address
First Line	:	3355 SAINT JOHNS LN
Second Line	:	SUITE F
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-2605
Country	:	US
Telephone Number	:	410-465-5520
Fax Number	:	410-480-0110

Provider Business Practice Location Address
First Line	:	3355 SAINT JOHNS LN
Second Line	:	SUITE F
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-2605
Country	:	US
Telephone Number	:	410-465-5520
Fax Number	:	410-480-0110

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

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	07/08/2007

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