Provider Demographics
NPI:1487062907
Name:CLEARY, BETH (PMHNP, RN)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:CLEARY
Suffix:
Gender:F
Credentials:PMHNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 PROVIDENCE ST
Mailing Address - Street 2:
Mailing Address - City:WEST WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02893-2508
Mailing Address - Country:US
Mailing Address - Phone:401-615-2800
Mailing Address - Fax:
Practice Address - Street 1:186 PROVIDENCE ST
Practice Address - Street 2:
Practice Address - City:WEST WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02893
Practice Address - Country:US
Practice Address - Phone:401-615-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-28
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2264984163W00000X, 363LP0808X
RIAPRN01978363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
RICAPRN01978OtherCAPRN
RIAPRN01978OtherAPRN LICENSE
RIRN62078OtherRN LICENSE