Provider Demographics
NPI:1063787968
Name:MCCLARY, LISA MARIE (LMSW)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARIE
Last Name:MCCLARY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 SEWARD ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14608-2848
Mailing Address - Country:US
Mailing Address - Phone:585-328-7454
Mailing Address - Fax:585-464-6195
Practice Address - Street 1:465 SEWARD ST
Practice Address - Street 2:465 SEWARD STREET
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14608-2848
Practice Address - Country:US
Practice Address - Phone:585-328-7454
Practice Address - Fax:585-464-6195
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-12
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0858841041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool