Healthcare Provider Details

I. General information

NPI: 1467380915
Provider Name (Legal Business Name): THE NURTURED BLOOM THERAPY, LCSW, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 VETERANS MEMORIAL HWY
COMMACK NY
11725-4316
US

IV. Provider business mailing address

500 PORTION RD STE 12
LAKE RONKONKOMA NY
11779-4587
US

V. Phone/Fax

Practice location:
  • Phone: 631-380-4999
  • Fax: 631-318-6072
Mailing address:
  • Phone: 631-380-4999
  • Fax: 631-318-6072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: CAITLIN SILVERSTEIN
Title or Position: OWNER, PRESIDENT
Credential: LCSW
Phone: 631-380-4999