Provider Demographics
NPI:1265030639
Name:ROSENTHAL, DEBRA (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:ROSENTHAL
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14714 72ND AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2544
Mailing Address - Country:US
Mailing Address - Phone:201-874-2960
Mailing Address - Fax:
Practice Address - Street 1:147 PRINCE ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-3022
Practice Address - Country:US
Practice Address - Phone:718-536-2958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
11937539103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst