Provider Demographics
NPI:1528368107
Name:O'GRADY, ANNALISE MARIE
Entity Type:Individual
Prefix:
First Name:ANNALISE
Middle Name:MARIE
Last Name:O'GRADY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 SKY VALLEY DR APT F102
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-9116
Mailing Address - Country:US
Mailing Address - Phone:831-594-8372
Mailing Address - Fax:
Practice Address - Street 1:1101 W MOANA LN STE 2
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4734
Practice Address - Country:US
Practice Address - Phone:775-337-2394
Practice Address - Fax:775-337-9570
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health