Provider Demographics
NPI:1134156110
Name:ROSENTHAL, RONALD L (PHD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:L
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 1:10691 N KENDALL DR
Mailing Address - Street 2:SUITE 314
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1551
Mailing Address - Country:US
Mailing Address - Phone:305-598-0013
Mailing Address - Fax:305-598-0014
Practice Address - Street 1:10691 N KENDALL DR
Practice Address - Street 2:SUITE 314
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1551
Practice Address - Country:US
Practice Address - Phone:305-598-0013
Practice Address - Fax:305-598-0014
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4847103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59458Medicare ID - Type Unspecified
FLR03827Medicare UPIN