Provider Demographics
NPI:1710054812
Name:CLEARY, DOROTHY A (MFTI)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:A
Last Name:CLEARY
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:DORY
Other - Middle Name:
Other - Last Name:CLEARY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFTI
Mailing Address - Street 1:PO BOX 6372
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926
Mailing Address - Country:US
Mailing Address - Phone:530-345-4403
Mailing Address - Fax:
Practice Address - Street 1:592 RIO LINDO AVENUE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926
Practice Address - Country:US
Practice Address - Phone:530-891-2775
Practice Address - Fax:530-895-6547
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF48821106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist