Provider Demographics
NPI:1497427793
Name:LAGARDE, CLAREANNE B (PSYD)
Entity Type:Individual
Prefix:
First Name:CLAREANNE
Middle Name:B
Last Name:LAGARDE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 VAN RIPER AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-1326
Mailing Address - Country:US
Mailing Address - Phone:973-489-3584
Mailing Address - Fax:
Practice Address - Street 1:82 VAN RIPER AVE FL 1
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-1326
Practice Address - Country:US
Practice Address - Phone:973-489-3584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023030103TF0200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR191649OtherCPH & ASSOCIATES