Provider Demographics
NPI:1528219532
Name:ORTH, RAINER ANDREAS (LCSW)
Entity type:Individual
Prefix:MR
First Name:RAINER
Middle Name:ANDREAS
Last Name:ORTH
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 1:555 KENWOOD PL
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-1651
Mailing Address - Country:US
Mailing Address - Phone:718-983-8872
Mailing Address - Fax:718-983-0348
Practice Address - Street 1:234 COLUMBIA AVE STE A
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-4132
Practice Address - Country:US
Practice Address - Phone:201-928-0968
Practice Address - Fax:718-983-0348
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJN44SC04780800104100000X
NY050466104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker