Provider Demographics
NPI:1598352049
Name:CLEARY, KRISTEN (LCSW-C)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:CLEARY
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3611 MAROON LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-2948
Mailing Address - Country:US
Mailing Address - Phone:808-589-6716
Mailing Address - Fax:
Practice Address - Street 1:111 CENTERWAY STE C2
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-1808
Practice Address - Country:US
Practice Address - Phone:240-670-4050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD186431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical