MEDICARE: MR. SCOTT JEFFERY ROSENTHAL L.C.S.W.

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	149005251	IL

General Provider Information

NPI Number	:	1720351612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SCOTT JEFFERY ROSENTHAL L.C.S.W.

Provider Business Mailing Address
First Line	:	290 N RAND RD
Second Line	:	SUITE D
City	:	LAKE ZURICH
State	:	IL
Zip	:	60047-2213
Country	:	US
Telephone Number	:	888-261-2178
Fax Number	:	847-847-7495

Provider Business Practice Location Address
First Line	:	290 N RAND RD
Second Line	:	SUITE D
City	:	LAKE ZURICH
State	:	IL
Zip	:	60047-2213
Country	:	US
Telephone Number	:	888-261-2178
Fax Number	:	847-847-7495

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

Provider Enumeration Date	:	02/23/2012
Last Update Date	:	02/04/2016

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