Provider Demographics
NPI:1386624104
Name:ROSENTHAL, RONALD (PHD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:
Last Name:ROSENTHAL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:977 LAKEVIEW PARKWAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:VERNON HLLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061
Mailing Address - Country:US
Mailing Address - Phone:312-618-1921
Mailing Address - Fax:847-816-8881
Practice Address - Street 1:977 LAKEVIEW PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1400
Practice Address - Country:US
Practice Address - Phone:312-618-1921
Practice Address - Fax:847-816-8881
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical