Healthcare Provider Details

I. General information

NPI: 1679272629
Provider Name (Legal Business Name): LARISSA BRUM CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2023
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 TISBURY ST
NEW BEDFORD MA
02745-5731
US

IV. Provider business mailing address

11 TISBURY ST
NEW BEDFORD MA
02745-5731
US

V. Phone/Fax

Practice location:
  • Phone: 774-263-1254
  • Fax: 844-909-4669
Mailing address:
  • Phone: 774-262-1254
  • Fax: 844-909-4669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberCPM00014
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: