Provider Demographics
NPI:1295802239
Name:CLEARY, PAMELA M (LCSW C)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:M
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 1:2336 GODDARD PARKWAY
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801
Mailing Address - Country:US
Mailing Address - Phone:410-334-6961
Mailing Address - Fax:410-334-6960
Practice Address - Street 1:29520 CANVASBACK DR
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-7124
Practice Address - Country:US
Practice Address - Phone:410-822-5007
Practice Address - Fax:410-822-5569
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD092191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD522156095OtherAMERICAN PSYCH SYSTEM
MD522156095OtherNCPPO
MD609550002Medicaid
MDLM49EAOtherCAREFIRST BCBS GROUP
MD259147000OtherMAGELLAN GROUP
517251OtherUHC MAMSI GROUP#
MD0033OtherCAREFIRST BCBS FEDERAL
MD2854541-000OtherMAGELLAN PIN
MD892878-01OtherCAREFIRST BCBS
DCR968OtherCAREFIRST FEDERAL GROUP
DCR968OtherCAREFIRST FEDERAL GROUP
MD742LQ668Medicare PIN