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NPI Code Detail

MEDICARE: MRS. EMMANOELLE AJAIME O'GRADY LCSW-C

MEDICARE: MRS. EMMANOELLE AJAIME O'GRADY LCSW-C
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
11041C0700XClinical Social Worker17972MD

General Provider Information

NPI Number : 1558753863
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. EMMANOELLE AJAIME O'GRADY LCSW-C
Provider Business Mailing Address
First Line : 9627 PHILADELPHIA RD STE 160
Second Line :
City : ROSEDALE
State : MD
Zip : 21237-4157
Country : US
Telephone Number : 410-929-2404
Fax Number :
Provider Business Practice Location Address
First Line : 9627 PHILADELPHIA RD STE 160
Second Line :
City : ROSEDALE
State : MD
Zip : 21237-4157
Country : US
Telephone Number : 410-929-2404
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2015
Last Update Date : 11/11/2021

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Directions to “ MRS. EMMANOELLE AJAIME O'GRADY LCSW-C” Practice Location

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