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General NPI Number Information
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NPI Number | 1528625654
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Entity Type | Individual
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Provider Name | BRENDAN GEORGE O'GRADY LCSW
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Gender | Male
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Dates
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Enumeration Date | 05/23/2019
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Last Update Date | 03/03/2021
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Provider Practice Location Address
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Address Line | 501 S UNION AVE FL 2
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City | HAVRE DE GRACE
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State | MD
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Zip | 21078-3493
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Country | US
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Telephone | 443-843-8099
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Fax | 443-843-8023
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Provider Business Mailing Address
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Address Line | 1305 ONTARIO ST
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City | HAVRE DE GRACE
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State | MD
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Zip | 21078-2527
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Country | US
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Telephone | 443-955-2673
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 23117
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License Number State | MD
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