Provider Demographics
NPI:1053869040
Name:JANSE VAN RENSBURG, CHRISTOFFEL J (LCSW)
Entity type:Individual
Prefix:
First Name:CHRISTOFFEL
Middle Name:J
Last Name:JANSE VAN RENSBURG
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 BALLSTON AVE
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-4723
Mailing Address - Country:US
Mailing Address - Phone:518-587-8008
Mailing Address - Fax:518-587-8241
Practice Address - Street 1:10 MCKOWN ROAD
Practice Address - Street 2:SUITE 220
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-3496
Practice Address - Country:US
Practice Address - Phone:518-763-9912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-19
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0894091041C0700X, 1041C0700X
NY054047101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health