Provider Demographics
NPI:1366806366
Name:LEARY, TERI (TEACHER)
Entity type:Individual
Prefix:MS
First Name:TERI
Middle Name:
Last Name:LEARY
Suffix:
Gender:F
Credentials:TEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 FOSTER AVE
Mailing Address - Street 2:53
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-1053
Mailing Address - Country:US
Mailing Address - Phone:917-893-9918
Mailing Address - Fax:
Practice Address - Street 1:2015 FOSTER AVE
Practice Address - Street 2:53
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-1053
Practice Address - Country:US
Practice Address - Phone:347-733-2576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-06
Last Update Date:2020-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3576730174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist