Provider Demographics
NPI:1063566719
Name:ROSENTHAL, DAVID H (LICSW)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:H
Last Name:ROSENTHAL
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 WALLING RD
Mailing Address - Street 2:
Mailing Address - City:ADAMS
Mailing Address - State:MA
Mailing Address - Zip Code:01220-9636
Mailing Address - Country:US
Mailing Address - Phone:413-743-9534
Mailing Address - Fax:
Practice Address - Street 1:333 EAST ST
Practice Address - Street 2:BRIEN CENTER
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-5312
Practice Address - Country:US
Practice Address - Phone:413-499-0412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10153631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA31633OtherHEALTH NEW ENGLAND
MA31633OtherHEALTH NEW ENGLAND