Healthcare Provider Details

I. General information

NPI: 1336055052
Provider Name (Legal Business Name): BLOSSOMING MINDS SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 FLINT PL
ELMONT NY
11003-3613
US

IV. Provider business mailing address

115 FLINT PL
ELMONT NY
11003-3613
US

V. Phone/Fax

Practice location:
  • Phone: 917-325-7342
  • Fax:
Mailing address:
  • Phone: 917-325-7342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MS. EDWOUINE FLEURY- SWIFT
Title or Position: SPECIAL INSTRUCTOR/ABA PROVIDER
Credential: MS.ED
Phone: 917-325-7342