Healthcare Provider Details

I. General information

NPI: 1053869040
Provider Name (Legal Business Name): CHRISTOFFEL J JANSE VAN RENSBURG LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2016
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MCKOWN ROAD SUITE 220
ALBANY NY
12203-3496
US

IV. Provider business mailing address

359 BALLSTON AVE
SARATOGA SPGS NY
12866-4723
US

V. Phone/Fax

Practice location:
  • Phone: 518-763-9912
  • Fax:
Mailing address:
  • Phone: 518-587-8008
  • Fax: 518-587-8241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089409
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: