Provider Demographics
NPI:1477121028
Name:PEACEFUL SOUL THERAPEUTIC SERVICES
Entity Type:Organization
Organization Name:PEACEFUL SOUL THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTELLO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW LCADC
Authorized Official - Phone:856-267-0499
Mailing Address - Street 1:535 ROUTE 38 EAST
Mailing Address - Street 2:SUITE 149C
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-0811
Mailing Address - Country:US
Mailing Address - Phone:856-267-0499
Mailing Address - Fax:
Practice Address - Street 1:535 ROUTE 38 STE 149C
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-2953
Practice Address - Country:US
Practice Address - Phone:856-655-6635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-10
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251K00000XAgenciesPublic Health or WelfareGroup - Multi-Specialty