=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972293470
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAY I. ROSENTHAL LICENSED CLINICAL SOCIAL WORKER INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2023
-----------------------------------------------------
Last Update Date | 05/09/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4579 DON TOMASO DR APT 5
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90008-4138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-537-8950
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4579 DON TOMASO DR APT 5
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90008-4138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-537-8950
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR & CLINICIAN
-----------------------------------------------------
Name | MR. JAY ROSENTHAL
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 213-537-8950
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------