Provider Demographics
NPI:1992820963
Name:BARTH, BETH ROSENTHAL (MSW R LCSW)
Entity type:Individual
Prefix:MS
First Name:BETH
Middle Name:ROSENTHAL
Last Name:BARTH
Suffix:
Gender:F
Credentials:MSW R LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2535
Mailing Address - Street 2:
Mailing Address - City:SAG HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11963-0116
Mailing Address - Country:US
Mailing Address - Phone:631-725-8510
Mailing Address - Fax:
Practice Address - Street 1:102 LAUREL LANE
Practice Address - Street 2:
Practice Address - City:SAG HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11963-0116
Practice Address - Country:US
Practice Address - Phone:631-725-8510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0636321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
7342543OtherVALUE OPTIONS
NY49331OtherUNITED HEALTH CARE
NY3590660OtherCAQHH 11235360
NY49331OtherUNITED HEALTH CARE
NYN683V1Medicare ID - Type Unspecified