Provider Demographics
NPI:1033278932
Name:ROSENTHAL, TERRI
Entity Type:Individual
Prefix:MS
First Name:TERRI
Middle Name:
Last Name:ROSENTHAL
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TERRI
Other - Middle Name:
Other - Last Name:ROSENTHAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:512 REDONDO AVE STE C
Mailing Address - Street 2:LONG BEACH, CA 90814
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90814-5128
Mailing Address - Country:US
Mailing Address - Phone:562-989-8777
Mailing Address - Fax:562-426-8016
Practice Address - Street 1:512 REDONDO AVE STE C
Practice Address - Street 2:LONG BEACH, CA 90814
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90814-5128
Practice Address - Country:US
Practice Address - Phone:562-989-8777
Practice Address - Fax:562-426-8016
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 23709106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist