Provider Demographics
NPI:1952880528
Name:ROSENTHAL, ELIZABETH ALISON (PSYD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ALISON
Last Name:ROSENTHAL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 GLENBROOK RD APT 7G
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-2950
Mailing Address - Country:US
Mailing Address - Phone:203-536-5632
Mailing Address - Fax:
Practice Address - Street 1:421 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-1339
Practice Address - Country:US
Practice Address - Phone:845-353-3399
Practice Address - Fax:845-353-2272
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022769103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical