Bloom Mental Wellness Center, LLC

Primary specialty

Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0808X

Legal business name

BLOOM MENTAL WELLNESS CENTER, LLC

Practice address

208 Main St Ste 110
Milford, MA 01757-2502

Phone

(508) 297-8603

Fax

(508) 484-6226

NPI assigned

Jan 16, 2026

Last updated

Feb 16, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Maurine KisobNPI 1841990462

Title

Executive Director

Phone

(508) 297-8603

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Maurine Aza Kisob

  • Psychiatric/Mental Health Registered Nurse
  • Framingham, MA
  • NPI 1841990462
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1768521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1771200000000",
    "number": "1053270967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 MAIN ST STE 110",
            "city": "MILFORD",
            "state": "MA",
            "postal_code": "017572502",
            "telephone_number": "508-297-8603",
            "fax_number": "508-484-6226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 MAIN ST STE 110",
            "city": "MILFORD",
            "state": "MA",
            "postal_code": "017572502",
            "telephone_number": "508-297-8603",
            "fax_number": "508-484-6226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOM MENTAL WELLNESS CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-01-16",
        "last_updated": "2026-02-16",
        "certification_date": "2026-02-16",
        "status": "A",
        "authorized_official_last_name": "KISOB",
        "authorized_official_first_name": "MAURINE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "508-297-8603"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Blasser
• Ian Chandler Blight
• Amy Lee Bliss
• Kelly Gwen Bliss
• Lori Bliss
• Sam Bloom, DO
• Tzvi Bluestone, M.D.
• Madison Blum
• Shantalle Akosua Boateng
• Elizabeth O'Brien Boback

• Psychiatric/Mental Health Registered Nurse in Milford, MA
• Providers in Milford, MA by specialty
• Psychiatric/Mental Health Registered Nurse in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.