Provider Demographics
NPI:1578910766
Name:LOTUS BLOSSOM PSYCHOTHERAPY, LLC.
Entity Type:Organization
Organization Name:LOTUS BLOSSOM PSYCHOTHERAPY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GERALDINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:VIGGIANI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:732-616-6162
Mailing Address - Street 1:27 STATE ROUTE 35
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5 PONDEROSA DR
Practice Address - Street 2:
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722-2219
Practice Address - Country:US
Practice Address - Phone:732-616-6162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC056551001041C0700X
NJ44SC056663001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty