Provider Demographics
NPI:1891860896
Name:ROSENTHAL, ALICE M (LICENSED CLINICAL SO)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:M
Last Name:ROSENTHAL
Suffix:
Gender:F
Credentials:LICENSED CLINICAL SO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 CROSBY BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14226
Mailing Address - Country:US
Mailing Address - Phone:716-835-2955
Mailing Address - Fax:
Practice Address - Street 1:4511 HARLEM ROAD
Practice Address - Street 2:SUITE 14
Practice Address - City:SNYDER
Practice Address - State:NY
Practice Address - Zip Code:14226
Practice Address - Country:US
Practice Address - Phone:716-833-2299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0234071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
000510980001OtherBLUE CR SHIELD OF WNY
6207982OtherUNIVERA AND INDEPENDENT H
000510980001OtherBLUE CR SHIELD OF WNY