Provider Demographics
NPI:1285141077
Name:O'GRADY, CHRISTINE (LCSW)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:O'GRADY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 WEST ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3008
Mailing Address - Country:US
Mailing Address - Phone:860-840-8190
Mailing Address - Fax:
Practice Address - Street 1:28 CRESCENT ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3654
Practice Address - Country:US
Practice Address - Phone:860-358-4825
Practice Address - Fax:860-358-4457
Is Sole Proprietor?:No
Enumeration Date:2018-01-03
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT009985OtherCT DEPARTMENT OF PUBLIC HEALTH