Provider Demographics
NPI:1437375573
Name:O'GRADY, SUSAN J (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:J
Last Name:O'GRADY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1855 SAN MIGUEL DRIVE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5214
Mailing Address - Country:US
Mailing Address - Phone:925-938-6786
Mailing Address - Fax:925-256-8723
Practice Address - Street 1:1855 SAN MIGUEL DRIVE
Practice Address - Street 2:SUITE 11
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5214
Practice Address - Country:US
Practice Address - Phone:925-938-6786
Practice Address - Fax:925-256-8723
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10993103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical