Provider Demographics
NPI:1417453390
Name:ROSENTHAL, RACHEL ILISE (LCSW-C)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ILISE
Last Name:ROSENTHAL
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4914 TOTHILL DR
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1872
Mailing Address - Country:US
Mailing Address - Phone:301-346-3835
Mailing Address - Fax:
Practice Address - Street 1:13508 COACHLAMP LN
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-5835
Practice Address - Country:US
Practice Address - Phone:301-346-3835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-01
Last Update Date:2018-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD168981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical