# BLOOM MENTAL WELLNESS CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053270967
- **Authorized official:** MAURINE KISOB (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (508) 297-8603

## Contact information

- **Practice address:** 208 MAIN ST STE 110, MILFORD, MA 01757-2502
- **Practice address phone:** (508) 297-8603
- **Practice address fax:** (508) 484-6226
- **Mailing address:** 208 MAIN ST STE 110, MILFORD, MA 01757-2502
- **Mailing address phone:** (508) 297-8603
- **Mailing address fax:** (508) 484-6226

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WP0808X | Psychiatric/Mental Health Registered Nurse | — | NULL | Yes |
| 163WP0808X | Psychiatric/Mental Health Registered Nurse | — | — | Yes |

## Other

- **Enumeration date:** 01/16/2026
- **Last updated:** 02/16/2026