Provider Demographics
NPI:1326321464
Name:BURRELL, SYLVESTER (LCSW-BACS)
Entity Type:Individual
Prefix:
First Name:SYLVESTER
Middle Name:
Last Name:BURRELL
Suffix:
Gender:M
Credentials:LCSW-BACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5145 MONTEGUT DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70126-3527
Mailing Address - Country:US
Mailing Address - Phone:504-615-4109
Mailing Address - Fax:504-822-4858
Practice Address - Street 1:5145 MONTEGUT DR
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70126-3527
Practice Address - Country:US
Practice Address - Phone:504-822-4850
Practice Address - Fax:504-822-4858
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2693101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty