Bloom Mental Health

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

BLOOM MENTAL HEALTH

Practice address

1121 Harding Hwy
Buena, NJ 08310-1537

Phone

(856) 839-5678

NPI assigned

Feb 12, 2026

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kelsee JacksonNPI 1104619659

Title

Owner

Phone

(856) 839-5678

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kelsee B Jackson

  • Clinical Social Worker
  • Rio Grande, NJ
  • NPI 1104619659

  Clinical

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1770854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770854400000",
    "number": "1023960978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4",
            "city": "BUENA",
            "state": "NJ",
            "postal_code": "083100004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1121 HARDING HWY",
            "city": "BUENA",
            "state": "NJ",
            "postal_code": "083101537",
            "telephone_number": "856-839-5678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOM MENTAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-02-12",
        "last_updated": "2026-02-12",
        "certification_date": "2026-02-12",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "KELSEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "856-839-5678"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Advoserv of New Jersey, Inc.
• Matthew Caverow, MPT
• Ludmila Chumak, PA-C
• Laura Cintron, MSW, LSWPENDING LCSW
• Anael Destin Delice Jr., D.O.
• Roger Duckett

• All providers in Buena, NJ
• Clinical Social Worker in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.