Individual
MRS. KELLY ANN PASSANISI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC, LCADC, NCC
Contact information
Practice address
1 BETHANY RD STE 69, HAZLET, NJ 07730-1668
(732) 600-0342
Mailing address
20 BROOK ST, RED BANK, NJ 07701-5802
(732) 600-0342
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
37PC00599400
NJ
101YA0400X
Addiction (Substance Use Disorder) Counselor
37LC00272900
NJ
Other
Enumeration date
12/12/2017
Last updated
09/18/2020
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