Blossom Counseling Services LCSW PLLC
Organization Active NPI Clinical Social Worker · Southampton, NY
NPI 1942095682 · NPPES record last updated Apr 14, 2025
Key facts
- NPI
- 1942095682
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Social Worker 1041C0700X
- Legal business name
- BLOSSOM COUNSELING SERVICES LCSW PLLC
- Practice address
- 40 Montauk Hwy
Southampton, NY 11968-4119 - Phone
- (631) 953-3249
- NPI assigned
- Apr 14, 2025
- Organization subpart
- No
Authorized official
- Name
- Aiyana Smith, LCSW
- Title
- Owner
- Phone
- (631) 953-3249
Practitioners 2
-
Christine Cantrell, LCSW, CASAC
-
Aiyana Smith, LCSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20260105001148 | NY | Part B Supplier - Clinic/Group Practice | 4385130814 |
Receives reassigned benefits from 2 practitioners Practice locations: Saint James, NY |
National Provider Directory
Locations
40 Montauk Hwy
Southampton, NY 11968
Phone (631) 953-3249
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | Yes |
Addresses
Primary practice location
40 Montauk Hwy
Southampton, NY 11968-4119
Mailing address
26 Hill St Ste 114
Southampton, NY 11968-5317
Other providers in Southampton, NY
- Gaurav Bhardwaj
- Saira Zia Bhatti
- Stephany Blatty
- George Bleicher
- Blossom Counseling Services
- Megan Jean Bock
- Premsai Bondalapati
- James Brady
- Christine Brennan
- Gary Neal Brenner
All providers in Southampton, NY · Clinical Social Worker in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 14, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.