Provider Demographics
NPI:1679537344
Name:ROSENTHAL, DIANE CAROL (LICSW MSW)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:CAROL
Last Name:ROSENTHAL
Suffix:
Gender:F
Credentials:LICSW MSW
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:C
Other - Last Name:BELDEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:78 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346
Mailing Address - Country:US
Mailing Address - Phone:508-947-4969
Mailing Address - Fax:
Practice Address - Street 1:333 UNION ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740
Practice Address - Country:US
Practice Address - Phone:508-990-0852
Practice Address - Fax:508-990-4447
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10162241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
345924OtherTRICARE MHN
87726OtherUNITED BEHAVIORAL HEALTHC
MAPO4745OtherBLUE CROSS
497362OtherVALUE OPTIONS
53725600OtherMAGELLAN
5668187OtherAETNA
87726OtherUNITED BEHAVIORAL HEALTHC