Provider Demographics
NPI:1609693639
Name:NEARY, KEVIN (LCSW)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:NEARY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 N MAIN ST UNIT 308
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53027-1576
Mailing Address - Country:US
Mailing Address - Phone:920-265-9570
Mailing Address - Fax:
Practice Address - Street 1:225 N MAIN ST UNIT 308
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:WI
Practice Address - Zip Code:53027-1576
Practice Address - Country:US
Practice Address - Phone:920-265-9570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI119381231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical