Provider Demographics
NPI:1790708246
Name:ROSENTHAL, THOMASINE M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:THOMASINE
Middle Name:M
Last Name:ROSENTHAL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:TAMMY
Other - Middle Name:M
Other - Last Name:ROSENTHAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:59 E RAYBURN RD
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07946-1503
Mailing Address - Country:US
Mailing Address - Phone:908-647-6611
Mailing Address - Fax:908-647-3538
Practice Address - Street 1:59 E RAYBURN RD
Practice Address - Street 2:
Practice Address - City:MILLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07946-1503
Practice Address - Country:US
Practice Address - Phone:908-647-6611
Practice Address - Fax:908-647-3538
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC000275001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJR0641816Medicare ID - Type Unspecified