Provider Demographics
NPI:1619360138
Name:SAWYER, MICHAEL GREEN (PHD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:GREEN
Last Name:SAWYER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:LEONARD
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1514 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2429
Mailing Address - Country:US
Mailing Address - Phone:504-842-4000
Mailing Address - Fax:
Practice Address - Street 1:2810 E CAUSEWAY APPROACH
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448
Practice Address - Country:US
Practice Address - Phone:985-898-7420
Practice Address - Fax:985-898-7271
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-09
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05283103T00000X
LA302051103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103T00000XBehavioral Health & Social Service ProvidersPsychologist