Healthcare Provider Details

I. General information

NPI: 1215425970
Provider Name (Legal Business Name): SAMANTHA ANN KOCHENASH LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2018
Last Update Date: 11/28/2025
Certification Date: 11/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 DR MARTIN LUTHER KING JR BLVD
NEWARK NJ
07102-1314
US

IV. Provider business mailing address

520 MLK JR BLVD
NEWARK NJ
07102-1314
US

V. Phone/Fax

Practice location:
  • Phone: 201-214-9363
  • Fax:
Mailing address:
  • Phone: 201-214-9363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35SI00713700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00723800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: