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General NPI Number Information
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NPI Number | 1427284975
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Entity Type | Individual
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Provider Name | RICARDO DWAYNE LAGRANGE PH.D.
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Gender | Male
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Dates
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Enumeration Date | 06/10/2009
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Last Update Date | 04/10/2012
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Provider Practice Location Address
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Address Line | 111 MICHIGAN AVE NW 6TH FLOOR - RESEARCH
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City | WASHINGTON
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State | DC
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Zip | 20010-2916
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Country | US
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Telephone | 202-476-4455
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Fax | 202-476-3425
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Provider Business Mailing Address
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Address Line | 7610 PENNSYLVANIA AVE #203
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City | FORESTVILLE
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State | MD
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Zip | 20747-4701
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY1000543
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 04481
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License Number State | MD
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