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General NPI Number Information
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NPI Number | 1124913462
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Entity Type | Organization
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Legal Business Name | BLOSSOM THERAPY LLC
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Dates
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Enumeration Date | 06/09/2025
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 2661 WHITNEY AVE
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City | HAMDEN
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State | CT
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Zip | 06518-2900
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Country | US
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Telephone | 203-293-6179
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Fax |
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Provider Business Mailing Address
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Address Line | 455 SHERMAN AVE APT 29
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City | HAMDEN
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State | CT
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Zip | 06518-2166
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Country | US
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Telephone | 914-417-7404
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | JORDYN HERMAN
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Credential | LCSW
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Telephone | 914-417-7404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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