Healthcare Provider Details

I. General information

NPI: 1356144661
Provider Name (Legal Business Name): GRACE ELIZABETH LAGRANGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GRACIE ELIZABETH LAGRANGE

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 ORONO RD
PORTLAND ME
04102-1106
US

IV. Provider business mailing address

55 MADELINE ST
PORTLAND ME
04103-1717
US

V. Phone/Fax

Practice location:
  • Phone: 207-874-8205
  • Fax:
Mailing address:
  • Phone: 207-232-4046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberMC25238
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: