Provider Demographics
NPI:1427284975
Name:LAGRANGE, RICARDO DWAYNE (PHD)
Entity type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:DWAYNE
Last Name:LAGRANGE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7610 PENNSYLVANIA AVE
Mailing Address - Street 2:#203
Mailing Address - City:FORESTVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20747-4701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 MICHIGAN AVE NW
Practice Address - Street 2:6TH FLOOR - RESEARCH
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2916
Practice Address - Country:US
Practice Address - Phone:202-476-4455
Practice Address - Fax:202-476-3425
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1000543103TC0700X
MD04481103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD036596300Medicaid
MD417682100Medicaid
MD417682101Medicaid