Provider Demographics
NPI:1689709248
Name:SARGENT, LESTER (MA PSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:LESTER
Middle Name:
Last Name:SARGENT
Suffix:
Gender:M
Credentials:MA PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3711 MAIN STREET
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CHAPMANVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25508
Mailing Address - Country:US
Mailing Address - Phone:304-855-5886
Mailing Address - Fax:304-855-5889
Practice Address - Street 1:3711 MAIN STREET
Practice Address - Street 2:SUITE 5
Practice Address - City:CHAPMANVILLE
Practice Address - State:WV
Practice Address - Zip Code:25508
Practice Address - Country:US
Practice Address - Phone:304-855-5886
Practice Address - Fax:304-855-5889
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV799103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical