Healthcare Provider Details

I. General information

NPI: 1346170016
Provider Name (Legal Business Name): JOSEPH KEVIN DELAGRANGE MSSA, LISW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2053 WINDHAM ST NE
CANTON OH
44721-2529
US

IV. Provider business mailing address

2053 WINDHAM ST NE
CANTON OH
44721-2529
US

V. Phone/Fax

Practice location:
  • Phone: 330-592-6054
  • Fax:
Mailing address:
  • Phone: 330-592-6054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI.2608195
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: