Provider Demographics
NPI:1063518306
Name:ROSENTHAL, GAY (MA, LP)
Entity type:Individual
Prefix:MS
First Name:GAY
Middle Name:
Last Name:ROSENTHAL
Suffix:
Gender:F
Credentials:MA, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17538 70TH PLACE NORTH
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311
Mailing Address - Country:US
Mailing Address - Phone:763-496-1151
Mailing Address - Fax:763-496-1307
Practice Address - Street 1:15 GROVELAND TERRACE
Practice Address - Street 2:SUITE 305
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403
Practice Address - Country:US
Practice Address - Phone:952-930-7546
Practice Address - Fax:612-374-4661
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1844103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent