Provider Demographics
NPI:1710041850
Name:CLEARY, MAUREEN (SCHOOL/CLINICAL PSYC)
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:
Last Name:CLEARY
Suffix:
Gender:F
Credentials:SCHOOL/CLINICAL PSYC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 566
Mailing Address - Street 2:
Mailing Address - City:CARNATION
Mailing Address - State:WA
Mailing Address - Zip Code:98014-0566
Mailing Address - Country:US
Mailing Address - Phone:612-723-5536
Mailing Address - Fax:
Practice Address - Street 1:14040 NE 181ST ST
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-4373
Practice Address - Country:US
Practice Address - Phone:651-642-1704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WATE61047907103TC0700X
MNLP1432103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN770353800Medicaid
MN620000271Medicare ID - Type Unspecified