Provider Demographics
NPI:1619778180
Name:JILL R LEARY LICSW LLC
Entity type:Organization
Organization Name:JILL R LEARY LICSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:LEARY
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-823-5080
Mailing Address - Street 1:20 2ND AVE APT 517
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-4464
Mailing Address - Country:US
Mailing Address - Phone:617-823-5080
Mailing Address - Fax:
Practice Address - Street 1:20 2ND AVE APT 517
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-4464
Practice Address - Country:US
Practice Address - Phone:617-823-5080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty