Provider Demographics
NPI:1396013199
Name:ROSENTHAL, KEELEY WRAY (LSW)
Entity Type:Individual
Prefix:MRS
First Name:KEELEY
Middle Name:WRAY
Last Name:ROSENTHAL
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:MISS
Other - First Name:KEELEY
Other - Middle Name:BETH
Other - Last Name:WRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:130 HAMPSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-2880
Mailing Address - Country:US
Mailing Address - Phone:267-546-6763
Mailing Address - Fax:
Practice Address - Street 1:701 S BETHLEHEM PIKE
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-5818
Practice Address - Country:US
Practice Address - Phone:215-643-7676
Practice Address - Fax:215-643-4715
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW126891104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker