MEDICARE: ROBERT GARY ROSENTHAL LCSW

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	091553	NY

General Provider Information

NPI Number	:	1831769959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT GARY ROSENTHAL LCSW

Provider Business Mailing Address
First Line	:	344 W 23RD ST APT 8D
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10011-2270
Country	:	US
Telephone Number	:	347-831-3400
Fax Number	:

Provider Business Practice Location Address
First Line	:	344 W 23RD ST APT 8D
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10011-2270
Country	:	US
Telephone Number	:	347-831-3400
Fax Number	:

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

Provider Enumeration Date	:	06/30/2021
Last Update Date	:	06/30/2021

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