Healthcare Provider Details

I. General information

NPI: 1508203092
Provider Name (Legal Business Name): MAUREEN O'GRADY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2013
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4514 251ST ST STE 144
LITTLE NECK NY
11362-1339
US

IV. Provider business mailing address

3307 28TH AVE APT 2
ASTORIA NY
11103-4912
US

V. Phone/Fax

Practice location:
  • Phone: 631-521-5551
  • Fax:
Mailing address:
  • Phone: 631-521-5551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: