Provider Demographics
NPI:1750370672
Name:ROSENTHAL, STACIE R (MS,CGC)
Entity type:Individual
Prefix:MS
First Name:STACIE
Middle Name:R
Last Name:ROSENTHAL
Suffix:
Gender:F
Credentials:MS,CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 MORAY LN
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-4120
Mailing Address - Country:US
Mailing Address - Phone:407-622-0560
Mailing Address - Fax:
Practice Address - Street 1:147 MORAY LN
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-4120
Practice Address - Country:US
Practice Address - Phone:407-622-0560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS