Provider Demographics
NPI:1811571300
Name:SYLVESTER, AMIA (LSW)
Entity Type:Individual
Prefix:
First Name:AMIA
Middle Name:
Last Name:SYLVESTER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 869
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-0869
Mailing Address - Country:US
Mailing Address - Phone:973-592-6346
Mailing Address - Fax:
Practice Address - Street 1:543 VALLEY RD STE 9
Practice Address - Street 2:
Practice Address - City:UPPER MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1844
Practice Address - Country:US
Practice Address - Phone:732-902-2181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SLO6591500104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker