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NPI Code Detail

MEDICARE: THOMAS J CLEARY LCSW

MEDICARE: THOMAS J CLEARY LCSW
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 WorkerS10023TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
200S85QOTHERTXBLUE CROSS BLUE SHIELD
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1952300162
Entity Type Code : Individual
Provider Name (Legal Business Name) : THOMAS J CLEARY LCSW
Provider Business Mailing Address
First Line : 4860 RHEA RD
Second Line :
City : WICHITA FALLS
State : TX
Zip : 76308-4404
Country : US
Telephone Number : 940-500-4408
Fax Number : 940-386-1318
Provider Business Practice Location Address
First Line : 1708 DAYTON
Second Line :
City : WICHITA FALLS
State : TX
Zip : 76301-6110
Country : US
Telephone Number : 940-500-4408
Fax Number : 940-386-1318
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2005
Last Update Date : 03/09/2021

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Directions to “ THOMAS J CLEARY LCSW” Practice Location

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