| Lotus Blossom Psychotherapy, Llc. | |
|
5 Ponderosa Dr Colts Neck NJ 07722-2219 | |
| (732) 616-6162 | |
| Not Available |
| Full Name | Lotus Blossom Psychotherapy, Llc. |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 5 Ponderosa Dr, Colts Neck, New Jersey |
| Authorized Official Name and Position | Geraldine M Viggiani (OWNER/PARTNER) |
| Authorized Official Contact | 7326166162 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lotus Blossom Psychotherapy, Llc. 27 State Route 35 Eatontown NJ 07724 Ph: () - | Lotus Blossom Psychotherapy, Llc. 5 Ponderosa Dr Colts Neck NJ 07722-2219 Ph: (732) 616-6162 |
| NPI Number | 1578910766 |
|---|---|
| Provider Enumeration Date | 05/18/2016 |
| Last Update Date | 05/18/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578910766 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 44SC05655100 (New Jersey) | Primary |
| 1041C0700X | Social Worker - Clinical | 44SC05666300 (New Jersey) | Secondary |
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