Healthcare Provider Details

I. General information

NPI: 1164771168
Provider Name (Legal Business Name): RICHARD LOUIS SYLVESTER JR. PHD, MP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2012
Last Update Date: 02/05/2023
Certification Date: 02/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 RIVERSIDE DR
MONROE LA
71201-6211
US

IV. Provider business mailing address

622 RIVERSIDE DR
MONROE LA
71201-6211
US

V. Phone/Fax

Practice location:
  • Phone: 318-398-0945
  • Fax: 318-398-4314
Mailing address:
  • Phone: 318-398-0945
  • Fax: 318-398-4314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number330644
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: