Active NPI
Elissa Katherine Blom
- Behavior Technician
- Southborough, MA
National Provider Identifier
1356131122
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 333 Turnpike Rd Ste 101
Southborough, MA 01772-1755 - Phone
- (508) 970-6377
- NPI assigned
- May 7, 2025
- Last updated
- May 7, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
333 Turnpike Rd Ste 101
Southborough, MA 01772-1755
Mailing address
71 Orchard Hill Dr
Oxford, MA 01540-1822
Phone (774) 275-8919
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1746576000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1746576000000",
"number": "1356131122",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "71 ORCHARD HILL DR",
"city": "OXFORD",
"state": "MA",
"postal_code": "015401822",
"telephone_number": "774-275-8919",
"fax_number": "774-275-8919"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "333 TURNPIKE RD STE 101",
"city": "SOUTHBOROUGH",
"state": "MA",
"postal_code": "017721755",
"telephone_number": "508-970-6377"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLOM",
"first_name": "ELISSA",
"middle_name": "KATHERINE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-05-07",
"last_updated": "2025-05-07",
"certification_date": "2025-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southborough, MA
- Hanna Margaret Berry, NP
- Damian Bialonczyk, PHARMD
- James R. Bieber, M.D.
- Shennelle Bingham
- Mariah Black, RN, BSN, MSN, FNP-C
- Board Certified Footcare LLC (Paula Angelini, DPM)
- Catherine Mary Borella, PHARMD
- Boston Surgical Group, Inc.
- Lauren Rose Botelho, MSN, FNP-BC, RD, LDN
- Chelsea Bradway-Francis, MS. ED
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.