Provider Demographics
NPI:1902948144
Name:ROSENTHAL, PHILIP B (PHD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:B
Last Name:ROSENTHAL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 NEW HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-4854
Mailing Address - Country:US
Mailing Address - Phone:203-876-7441
Mailing Address - Fax:203-874-2965
Practice Address - Street 1:75 NEW HAVEN AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-4854
Practice Address - Country:US
Practice Address - Phone:203-876-7441
Practice Address - Fax:203-874-2965
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00571CT103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT620000055Medicare ID - Type Unspecified