MEDICARE: HALLIE ROSENTHAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	149021870	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710430343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALLIE ROSENTHAL

Provider Business Mailing Address
First Line	:	1960 N LINCOLN PARK W APT 710
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-5440
Country	:	US
Telephone Number	:	412-302-7086
Fax Number	:

Provider Business Practice Location Address
First Line	:	2801 N SHEFFIELD AVE FL 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-5003
Country	:	US
Telephone Number	:	813-077-3281
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2016
Last Update Date	:	02/02/2022

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Directions to “ HALLIE ROSENTHAL ” Practice Location

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