Lisa Simone Cleary, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW-22970 Issued in AZ

Practice address

550 S Montezuma St Ste a
Prescott, AZ 86303-4200

Phone

(404) 590-2029

NPI assigned

Dec 19, 2022

Last updated

Apr 22, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Lisa Simone Bourque Former name

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2021

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Willow Integration LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Prescott, AZ
  • NPI 1609703586
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1671408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776816000000",
    "number": "1669184966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3050 WINDSOR DR",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863014862",
            "telephone_number": "404-590-2039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 S MONTEZUMA ST STE A",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863034200",
            "telephone_number": "404-590-2029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLEARY",
        "first_name": "LISA",
        "middle_name": "SIMONE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-12-19",
        "last_updated": "2026-04-22",
        "certification_date": "2026-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AZ",
            "license": "LCSW-22970",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW009286",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "BOURQUE",
            "middle_name": "SIMONE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kathleen Carey Clarkin-Dedio, DC
• Claussen Collaborative Medical Clinic LLC
• Sarah Beth Claussen, FNP-C
• Clean Adventures of Sober Living, LLC
• Clear Choice Leasing (New Era Hearing)
• Eric F Cleland, PT
• Marybeth Cleland, RN
• Roxanne Clever, LMSW
• Gary N Cline, PMHNP
• Heide Cline, M.A., CCC-SLP

• Clinical Social Worker in Prescott, AZ
• Providers in Prescott, AZ by specialty
• Clinical Social Worker in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.