Provider Demographics
NPI:1518729912
Name:CHARNECKY, SAMANTHA LYNNE (LAC)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:LYNNE
Last Name:CHARNECKY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CONSTITUTION WAY
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:07416-2146
Mailing Address - Country:US
Mailing Address - Phone:862-293-2307
Mailing Address - Fax:
Practice Address - Street 1:145 DECKER RD STE 22ND
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:NJ
Practice Address - Zip Code:07405-1570
Practice Address - Country:US
Practice Address - Phone:862-801-0432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00591200101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health