Provider Demographics
NPI:1386868347
Name:ROSENTHAL, MICHAEL LOUIS (MSW LCSW EDD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LOUIS
Last Name:ROSENTHAL
Suffix:
Gender:M
Credentials:MSW LCSW EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 LINDEN LANE
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-3827
Mailing Address - Country:US
Mailing Address - Phone:609-921-1782
Mailing Address - Fax:609-921-2016
Practice Address - Street 1:35 LINDEN LANE
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-3827
Practice Address - Country:US
Practice Address - Phone:609-921-1782
Practice Address - Fax:609-921-2016
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC006599001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
2677588OtherAETNA