Healthcare Provider Details

I. General information

NPI: 1366354516
Provider Name (Legal Business Name): BRIDGE & BLOOM PSYCHIATRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 GROSSMAN DR STE 205
BRAINTREE MA
02184-4947
US

IV. Provider business mailing address

150 GROSSMAN DR STE 205
BRAINTREE MA
02184-4947
US

V. Phone/Fax

Practice location:
  • Phone: 617-852-3925
  • Fax:
Mailing address:
  • Phone: 617-852-3925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. XUAN NGUYEN
Title or Position: NURSE PRACTITIONER
Credential: DNP, PMHNP, AGPCNP
Phone: 617-852-3925