Provider Demographics
NPI:1801247804
Name:AUDREY CLEARY, PH.D.
Entity type:Organization
Organization Name:AUDREY CLEARY, PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEARY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:305-767-1108
Mailing Address - Street 1:5915 PONCE DE LEON BLVD
Mailing Address - Street 2:SUITE 19
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2435
Mailing Address - Country:US
Mailing Address - Phone:305-767-1108
Mailing Address - Fax:
Practice Address - Street 1:5915 PONCE DE LEON BLVD
Practice Address - Street 2:SUITE 19
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2435
Practice Address - Country:US
Practice Address - Phone:305-767-1108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-30
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8599103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty