Provider Demographics
NPI:1972293470
Name:JAY I. ROSENTHAL LICENSED CLINICAL SOCIAL WORKER INC.
Entity type:Organization
Organization Name:JAY I. ROSENTHAL LICENSED CLINICAL SOCIAL WORKER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR & CLINICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:213-537-8950
Mailing Address - Street 1:4579 DON TOMASO DR APT 5
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-4138
Mailing Address - Country:US
Mailing Address - Phone:213-537-8950
Mailing Address - Fax:
Practice Address - Street 1:4579 DON TOMASO DR APT 5
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-4138
Practice Address - Country:US
Practice Address - Phone:213-537-8950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty