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General NPI Number Information
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NPI Number | 1053869040
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Entity Type | Individual
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Provider Name | CHRISTOFFEL J JANSE VAN RENSBURG LCSW
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Gender | Male
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Dates
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Enumeration Date | 09/19/2016
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Last Update Date | 08/01/2023
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Provider Practice Location Address
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Address Line | 10 MCKOWN ROAD SUITE 220
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City | ALBANY
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State | NY
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Zip | 12203-3496
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Country | US
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Telephone | 518-763-9912
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Fax |
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Provider Business Mailing Address
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Address Line | 359 BALLSTON AVE
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City | SARATOGA SPGS
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State | NY
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Zip | 12866-4723
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Country | US
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Telephone | 518-587-8008
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Fax | 518-587-8241
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 089409
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License Number State | NY
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