Healthcare Provider Details

I. General information

NPI: 1245574987
Provider Name (Legal Business Name): MARGARET R. LARACY PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2012
Last Update Date: 07/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6917 ARLINGTON RD STE 303
BETHESDA MD
20814
US

IV. Provider business mailing address

11004 SUGARBUSH TER
ROCKVILLE MD
20852-3240
US

V. Phone/Fax

Practice location:
  • Phone: 240-630-8435
  • Fax:
Mailing address:
  • Phone: 240-630-8435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number05290
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810004655
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: