Active NPI
Robert Ethan Bloom, MSW
- Mental Health Counselor
- Marlborough, MA
National Provider Identifier
1891464095
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 15 Dickenson Way Apt 80L
Marlborough, MA 01752-4769 - Phone
- (508) 628-6570
- NPI assigned
- Sep 10, 2021
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
15 Dickenson Way Apt 80L
Marlborough, MA 01752-4769
Mailing address
1881 Worcester Rd
Framingham, MA 01701-5410
Other practice location 1
340 Maple St Ste 400
Marlborough, MA 01752-3200
Phone (508) 485-9300
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": "1631232000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1631232000000",
"number": "1891464095",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1881 WORCESTER RD",
"city": "FRAMINGHAM",
"state": "MA",
"postal_code": "017015410"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15 DICKENSON WAY APT 80L",
"city": "MARLBOROUGH",
"state": "MA",
"postal_code": "017524769",
"telephone_number": "508-628-6570"
}
],
"practiceLocations": [
{
"address_1": "340 Maple St Ste 400",
"address_purpose": "LOCATION",
"city": "Marlborough",
"state": "MA",
"postal_code": "017523200",
"country_code": "US",
"telephone_number": "508-485-9300",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BLOOM",
"first_name": "ROBERT",
"middle_name": "ETHAN",
"credential": "MSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-09-10",
"last_updated": "2021-09-10",
"certification_date": "2021-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marlborough, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.