Healthcare Provider Details

I. General information

NPI: 1811678758
Provider Name (Legal Business Name): SAMUEL MICHAEL ROSENTHAL LMHC-D, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: SAM ROSENTHAL LMHC-D, LPC

II. Dates (important events)

Enumeration Date: 07/25/2023
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 COURT ST STE 1614
BROOKLYN NY
11242-1116
US

IV. Provider business mailing address

26 COURT ST STE 1614
BROOKLYN NY
11242-1116
US

V. Phone/Fax

Practice location:
  • Phone: 929-249-2017
  • Fax:
Mailing address:
  • Phone: 929-249-2017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number016781
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC01207000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: