Provider Demographics
NPI:1336487065
Name:ROSENTHAL, JONATHAN MARK (LMSW)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:MARK
Last Name:ROSENTHAL
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-1804
Mailing Address - Country:US
Mailing Address - Phone:914-949-6640
Mailing Address - Fax:914-949-5429
Practice Address - Street 1:246 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-1804
Practice Address - Country:US
Practice Address - Phone:914-949-6640
Practice Address - Fax:914-949-5429
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY087502104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker