Provider Demographics
NPI:1902033095
Name:GRADY, MARGARET (PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:
Last Name:GRADY
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 POST RD STE M2
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07436-1619
Mailing Address - Country:US
Mailing Address - Phone:201-904-2230
Mailing Address - Fax:201-904-2232
Practice Address - Street 1:9 POST RD STE M2
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:NJ
Practice Address - Zip Code:07436-1619
Practice Address - Country:US
Practice Address - Phone:201-904-2230
Practice Address - Fax:201-904-2232
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00203000363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0423335Medicaid