Provider Demographics
NPI:1063146348
Name:RAINNER, SHAKERA (LCSW)
Entity type:Individual
Prefix:
First Name:SHAKERA
Middle Name:
Last Name:RAINNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 HAMPTON GATE DR
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-2507
Mailing Address - Country:US
Mailing Address - Phone:856-265-9533
Mailing Address - Fax:
Practice Address - Street 1:288 EGG HARBOR RD STE 9
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-3131
Practice Address - Country:US
Practice Address - Phone:856-720-0106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-13
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC060378001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical