Healthcare Provider Details

I. General information

NPI: 1730569013
Provider Name (Legal Business Name): KATHLEEN O'GRADY MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2015
Last Update Date: 06/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

934 PARKWAY AVE # 201
EWING NJ
08618-2308
US

IV. Provider business mailing address

934 PARKWAY AVE # 201
EWING NJ
08618-2308
US

V. Phone/Fax

Practice location:
  • Phone: 856-440-1050
  • Fax:
Mailing address:
  • Phone: 856-440-1050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05635600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: