Provider Demographics
NPI:1528625654
Name:O'GRADY, BRENDAN GEORGE (LCSW)
Entity type:Individual
Prefix:
First Name:BRENDAN
Middle Name:GEORGE
Last Name:O'GRADY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 ONTARIO ST
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-2527
Mailing Address - Country:US
Mailing Address - Phone:443-955-2673
Mailing Address - Fax:
Practice Address - Street 1:501 S UNION AVE FL 2
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-3493
Practice Address - Country:US
Practice Address - Phone:443-843-8099
Practice Address - Fax:443-843-8023
Is Sole Proprietor?:No
Enumeration Date:2019-05-23
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23117104100000X, 104100000X
MDADS080171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171100000XOther Service ProvidersAcupuncturist