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NPI Code Detail

MEDICARE: MR. GREGORY PAUL CLEARY LMSW

MEDICARE: MR. GREGORY PAUL CLEARY LMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker6801085229MI

General Provider Information

NPI Number : 1639197700
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GREGORY PAUL CLEARY LMSW
Provider Business Mailing Address
First Line : 1900 SILVER LAKE RD NW
Second Line : SUITE 110
City : NEW BRIGHTON
State : MN
Zip : 55112-1786
Country : US
Telephone Number : 651-379-1718
Fax Number : 651-379-1738
Provider Business Practice Location Address
First Line : 332 W SUPERIOR ST STE 300
Second Line :
City : DULUTH
State : MN
Zip : 55802-1844
Country : US
Telephone Number : 218-722-4379
Fax Number : 218-722-4333
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2006
Last Update Date : 07/24/2015

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