Healthcare Provider Details

I. General information

NPI: 1902181910
Provider Name (Legal Business Name): GLENER SEWELL SYLVESTER LCSW,BACS,C-SSWS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2011
Last Update Date: 10/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 MARIGNY ST
NEW ORLEANS LA
70122-5041
US

IV. Provider business mailing address

4600 MARIGNY ST
NEW ORLEANS LA
70122-5041
US

V. Phone/Fax

Practice location:
  • Phone: 504-453-5635
  • Fax: 504-282-2227
Mailing address:
  • Phone: 504-453-5635
  • Fax: 504-282-2227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1338
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number1338
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: