Provider Demographics
NPI:1497111223
Name:RATHJENS, GINA (LSW)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:RATHJENS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 RIVERVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:OCEANPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:07757-1115
Mailing Address - Country:US
Mailing Address - Phone:914-420-3284
Mailing Address - Fax:
Practice Address - Street 1:7 RIVERVIEW AVE
Practice Address - Street 2:
Practice Address - City:OCEANPORT
Practice Address - State:NJ
Practice Address - Zip Code:07757-1115
Practice Address - Country:US
Practice Address - Phone:914-420-3284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-08
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06057300104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker