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General NPI Number Information
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NPI Number | 1669184966
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Entity Type | Individual
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Provider Name | LISA SIMONE CLEARY LMSW
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Gender | Female
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Dates
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Enumeration Date | 12/19/2022
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 14 PEGGY CT NW
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City | MARIETTA
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State | GA
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Zip | 30064-1858
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Country | US
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Telephone | 404-590-2029
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Fax | 706-237-6503
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Provider Business Mailing Address
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Address Line | 3050 WINDSOR DR
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City | PRESCOTT
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State | AZ
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Zip | 86301-4862
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Country | US
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Telephone | 678-886-8027
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW009286
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License Number State | GA
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