Provider Demographics
NPI:1588863609
Name:ROSENTHAL, KENNETH (PHD, MSW)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:ROSENTHAL
Suffix:
Gender:M
Credentials:PHD, MSW
Other - Prefix:DR
Other - First Name:KENNETH
Other - Middle Name:
Other - Last Name:ROSENTHAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, MSW
Mailing Address - Street 1:19 FRIENDSHIP STREET
Mailing Address - Street 2:#240
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840
Mailing Address - Country:US
Mailing Address - Phone:401-849-1403
Mailing Address - Fax:
Practice Address - Street 1:19 FRIENDSHIP ST
Practice Address - Street 2:#240
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-2200
Practice Address - Country:US
Practice Address - Phone:401-849-1403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW002321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical