Provider Demographics
NPI:1811236409
Name:CLEARY, ASHLEY DIOGO (LMFT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:DIOGO
Last Name:CLEARY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 WOODSTOCK AVE
Mailing Address - Street 2:
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-1428
Mailing Address - Country:US
Mailing Address - Phone:401-578-9411
Mailing Address - Fax:
Practice Address - Street 1:108 W TOWN ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2239
Practice Address - Country:US
Practice Address - Phone:860-886-8233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-03
Last Update Date:2013-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001567106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist