Provider Demographics
NPI:1720351612
Name:ROSENTHAL, SCOTT JEFFERY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:JEFFERY
Last Name:ROSENTHAL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 N RAND RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-2213
Mailing Address - Country:US
Mailing Address - Phone:888-261-2178
Mailing Address - Fax:847-847-7495
Practice Address - Street 1:290 N RAND RD
Practice Address - Street 2:SUITE D
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-2213
Practice Address - Country:US
Practice Address - Phone:888-261-2178
Practice Address - Fax:847-847-7495
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490052511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical