Provider Demographics
NPI:1326245457
Name:CLEARY, PAMELA (LICSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:CLEARY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4826 CHICAGO AVE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-1001
Mailing Address - Country:US
Mailing Address - Phone:612-226-7029
Mailing Address - Fax:612-824-7341
Practice Address - Street 1:4826 CHICAGO AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-1001
Practice Address - Country:US
Practice Address - Phone:612-226-7029
Practice Address - Fax:612-824-7341
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN110151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical