Healthcare Provider Details

I. General information

NPI: 1275486821
Provider Name (Legal Business Name): BLOSSOMING MINDS COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2026
Last Update Date: 02/16/2026
Certification Date: 02/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 SPRUCE ST
ELMWOOD PARK NJ
07407-2760
US

IV. Provider business mailing address

60 SPRUCE ST
ELMWOOD PARK NJ
07407-2760
US

V. Phone/Fax

Practice location:
  • Phone: 201-719-3019
  • Fax:
Mailing address:
  • Phone: 201-719-3019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: NADA K SAMO
Title or Position: MS, LPC, NCC
Credential: LPC, NCC
Phone: 201-719-3019