Provider Demographics
NPI:1164771168
Name:SYLVESTER, RICHARD LOUIS JR (PHD, MP)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LOUIS
Last Name:SYLVESTER
Suffix:JR
Gender:M
Credentials:PHD, MP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-6211
Mailing Address - Country:US
Mailing Address - Phone:318-398-0945
Mailing Address - Fax:318-398-4314
Practice Address - Street 1:622 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-6211
Practice Address - Country:US
Practice Address - Phone:318-398-0945
Practice Address - Fax:318-398-4314
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2023-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
LA330644103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103T00000XBehavioral Health & Social Service ProvidersPsychologist