Provider Demographics
NPI:1679272629
Name:BRUM, LARISSA (CPM)
Entity type:Individual
Prefix:
First Name:LARISSA
Middle Name:
Last Name:BRUM
Suffix:
Gender:
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 SMITH NECK RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02748-1511
Mailing Address - Country:US
Mailing Address - Phone:774-271-7221
Mailing Address - Fax:
Practice Address - Street 1:11 TISBURY ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02745-5731
Practice Address - Country:US
Practice Address - Phone:774-263-1254
Practice Address - Fax:844-909-4669
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-28
Last Update Date:2025-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
MA176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula