Provider Demographics
NPI:1265760904
Name:ROSENTHAL, AMY MICHELLE (LCSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MICHELLE
Last Name:ROSENTHAL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:473 78TH ST APT 6
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3408
Mailing Address - Country:US
Mailing Address - Phone:917-627-1511
Mailing Address - Fax:
Practice Address - Street 1:75 MAIDEN LN RM 907
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-4615
Practice Address - Country:US
Practice Address - Phone:929-382-4251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0831121041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical