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NPI Code Detail

MEDICARE: ANNALISE MARIE O'GRADY

MEDICARE: ANNALISE MARIE O'GRADY
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1528368107
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNALISE MARIE O'GRADY
Provider Business Mailing Address
First Line : 1555 SKY VALLEY DR APT F102
Second Line :
City : RENO
State : NV
Zip : 89523-9116
Country : US
Telephone Number : 831-594-8372
Fax Number :
Provider Business Practice Location Address
First Line : 1101 W MOANA LN STE 2
Second Line :
City : RENO
State : NV
Zip : 89509-4734
Country : US
Telephone Number : 775-337-2394
Fax Number : 775-337-9570
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2010
Last Update Date : 10/28/2010

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Directions to “ ANNALISE MARIE O'GRADY ” Practice Location

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