Provider Demographics
NPI:1851907414
Name:SOUL WORK LLC
Entity Type:Organization
Organization Name:SOUL WORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PASSANISI
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LCADC
Authorized Official - Phone:732-600-0342
Mailing Address - Street 1:20 BROOK ST
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5802
Mailing Address - Country:US
Mailing Address - Phone:732-600-0342
Mailing Address - Fax:
Practice Address - Street 1:1 BETHANY RD STE 69
Practice Address - Street 2:
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1668
Practice Address - Country:US
Practice Address - Phone:732-600-0342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty