MEDICARE: JAY I. ROSENTHAL LICENSED CLINICAL SOCIAL WORKER INC.

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1972293470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAY I. ROSENTHAL LICENSED CLINICAL SOCIAL WORKER INC.

Provider Business Mailing Address
First Line	:	4579 DON TOMASO DR APT 5
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-4138
Country	:	US
Telephone Number	:	213-537-8950
Fax Number	:

Provider Business Practice Location Address
First Line	:	4579 DON TOMASO DR APT 5
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-4138
Country	:	US
Telephone Number	:	213-537-8950
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR & CLINICIAN
Name	:	MR. JAY ROSENTHAL
Credential	:	LCSW
Telephone Number	:	213-537-8950

Provider Enumeration Date	:	05/09/2023
Last Update Date	:	05/09/2023

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