Provider Demographics
NPI:1285695239
Name:ROSENTHAL, JUDITH LINDNER (PHD)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:LINDNER
Last Name:ROSENTHAL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 ABINGTON RD
Mailing Address - Street 2:SUITE 103B
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-4057
Mailing Address - Country:US
Mailing Address - Phone:330-664-9064
Mailing Address - Fax:
Practice Address - Street 1:2725 ABINGTON RD
Practice Address - Street 2:SUITE 103B
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-4057
Practice Address - Country:US
Practice Address - Phone:330-664-9064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3399103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHROCP17202Medicare ID - Type Unspecified