Provider Demographics
NPI:1275849150
Name:RACKOFF, CHANA
Entity Type:Individual
Prefix:MRS
First Name:CHANA
Middle Name:
Last Name:RACKOFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 RUTHERFORD BLVD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07014-1238
Mailing Address - Country:US
Mailing Address - Phone:973-773-8931
Mailing Address - Fax:
Practice Address - Street 1:411 RUTHERFORD BLVD
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07014-1238
Practice Address - Country:US
Practice Address - Phone:973-773-8931
Practice Address - Fax:201-624-7233
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC047178001041C0700X
NJ86175933591041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool