Provider Demographics
NPI:1558413013
Name:LAGARDE, HENRY JAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:JAY
Last Name:LAGARDE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 FRENCH STREET
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560
Mailing Address - Country:US
Mailing Address - Phone:337-367-6604
Mailing Address - Fax:337-367-6963
Practice Address - Street 1:217 FRENCH STREET
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560
Practice Address - Country:US
Practice Address - Phone:337-367-6604
Practice Address - Fax:337-367-6963
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA353103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1997943Medicaid
LA1997943Medicaid
LA56086Medicare ID - Type Unspecified