MEDICARE: ABIGAIL ROSE KOLLER KOCENIAK LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	37AC00920600	NJ

General Provider Information

NPI Number	:	1871421727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABIGAIL ROSE KOLLER KOCENIAK LAC

Provider Business Mailing Address
First Line	:	11 PINE DR
Second Line	:
City	:	BELVIDERE
State	:	NJ
Zip	:	07823-3029
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7 CARLA CT
Second Line	:
City	:	ROCKAWAY
State	:	NJ
Zip	:	07866-2201
Country	:	US
Telephone Number	:	862-243-5851
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2026
Last Update Date	:	05/11/2026

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