Integral Bloom, Inc.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

111055 Issued in MA

Legal business name

INTEGRAL BLOOM, INC.

Practice address

100 Summer St Ste 1600
Boston, MA 02110-2104

Phone

(857) 231-0376

Fax

(617) 412-3135

NPI assigned

Dec 31, 2014

Last updated

Sep 29, 2023By 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

Ms. Maria Camille Mellano, LICSWNPI 1578772588

Title

Owner, President

Phone

(617) 913-3898

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Enrollment records 1

Locations

Practitioners 2

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.

• Maria Mellano, LICSW

  • Social Worker
  • Somerville, MA
  • NPI 1578772588
  Medicare reassignment NPD Authorized official
• Tiffany Armstrong

  • Social Worker
  • Brockton, MA
  • NPI 1295261360

  Clinical

  NPD (past)

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

{
    "created_epoch": "1419984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695945600000",
    "number": "1265820070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 COMMON ST # H101",
            "city": "BELMONT",
            "state": "MA",
            "postal_code": "024784454",
            "telephone_number": "617-913-3898",
            "fax_number": "617-412-3135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 SUMMER ST STE 1600",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021102104",
            "telephone_number": "857-231-0376",
            "fax_number": "617-412-3135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRAL BLOOM, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-31",
        "last_updated": "2023-09-29",
        "certification_date": "2023-09-29",
        "status": "A",
        "authorized_official_last_name": "MELLANO",
        "authorized_official_first_name": "MARIA",
        "authorized_official_middle_name": "CAMILLE",
        "authorized_official_title_or_position": "OWNER, PRESIDENT",
        "authorized_official_telephone_number": "617-913-3898",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "111055",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Boston, MA
• Providers in Boston, MA by specialty
• Clinical Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2023; 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.