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General NPI Number Information
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NPI Number | 1164771168
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Entity Type | Individual
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Provider Name | RICHARD LOUIS SYLVESTER JR. PHD, MP
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Gender | Male
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Dates
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Enumeration Date | 09/05/2012
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Last Update Date | 02/05/2023
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Provider Practice Location Address
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Address Line | 622 RIVERSIDE DR
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City | MONROE
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State | LA
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Zip | 71201-6211
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Country | US
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Telephone | 318-398-0945
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Fax | 318-398-4314
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Provider Business Mailing Address
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Address Line | 622 RIVERSIDE DR
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City | MONROE
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State | LA
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Zip | 71201-6211
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Country | US
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Telephone | 318-398-0945
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Fax | 318-398-4314
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number | 330644
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License Number State | LA
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