Healthcare Provider Details

I. General information

NPI: 1952077281
Provider Name (Legal Business Name): KELLY SANTANA MAJOCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

274 GROVE ST
MONTCLAIR NJ
07042-4208
US

IV. Provider business mailing address

274 GROVE ST
MONTCLAIR NJ
07042-4208
US

V. Phone/Fax

Practice location:
  • Phone: 201-362-6955
  • Fax:
Mailing address:
  • Phone: 201-362-6955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00730700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC01231300
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number9061
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: