Provider Demographics
NPI:1437375565
Name:O'GRADY, DAVID D (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:D
Last Name:O'GRADY
Suffix:
Gender:M
Credentials:PHD
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Mailing Address - Street 1:1855 SAN MIGUEL DR
Mailing Address - Street 2:SUITE 11
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5279
Mailing Address - Country:US
Mailing Address - Phone:925-256-9696
Mailing Address - Fax:925-256-8723
Practice Address - Street 1:1600 S MAIN ST
Practice Address - Street 2:STE 177
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-8813
Practice Address - Country:US
Practice Address - Phone:925-256-9696
Practice Address - Fax:925-256-8723
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2017-03-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY9137103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
680283896OtherEIN
680283896OtherEIN