Provider Demographics
NPI:1265218770
Name:KOCHANOWSKI, MARTHA (LSW)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:KOCHANOWSKI
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 WOODSIDE RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-1533
Mailing Address - Country:US
Mailing Address - Phone:973-908-5616
Mailing Address - Fax:
Practice Address - Street 1:44 UNION AVE
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-1275
Practice Address - Country:US
Practice Address - Phone:201-399-7225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-31
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL07003800104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker