Provider Demographics
NPI:1598853723
Name:RAINER, PHILIP HOWARD (LCSWR)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:HOWARD
Last Name:RAINER
Suffix:
Gender:M
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 WARREN ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-2998
Mailing Address - Country:US
Mailing Address - Phone:518-462-6531
Mailing Address - Fax:518-462-0181
Practice Address - Street 1:650 WARREN ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-2998
Practice Address - Country:US
Practice Address - Phone:518-462-6531
Practice Address - Fax:518-462-0181
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0357241104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400003835Medicare PIN