Provider Demographics
NPI:1265820070
Name:INTEGRAL BLOOM, INC.
Entity Type:Organization
Organization Name:INTEGRAL BLOOM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:CAMILLE
Authorized Official - Last Name:MELLANO
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-913-3898
Mailing Address - Street 1:525 COMMON ST # H101
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-4454
Mailing Address - Country:US
Mailing Address - Phone:617-913-3898
Mailing Address - Fax:617-412-3135
Practice Address - Street 1:100 SUMMER ST STE 1600
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02110-2104
Practice Address - Country:US
Practice Address - Phone:857-231-0376
Practice Address - Fax:617-412-3135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-31
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1110551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty