Provider Demographics
NPI:1720754245
Name:BLOSSOMING LOTUS THERAPY LCSW PLLC
Entity type:Organization
Organization Name:BLOSSOMING LOTUS THERAPY LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HARDIAL
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCSW, PHD(C)
Authorized Official - Phone:516-254-9201
Mailing Address - Street 1:145 SUNRISE HWY STE 7
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-2500
Mailing Address - Country:US
Mailing Address - Phone:516-254-9201
Mailing Address - Fax:
Practice Address - Street 1:145 SUNRISE HWY STE 7
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-2500
Practice Address - Country:US
Practice Address - Phone:516-254-9201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-17
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1366893240OtherNPI