Individual
LEILA BASS FORMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
330 MOUNT AUBURN ST, CENTER FOR WOMEN, CAMBRIDGE, MA 02138-5502
(617) 499-5151
Mailing address
330 MOUNT AUBURN ST, CENTER FOR WOMEN, CAMBRIDGE, MA 02138-5502
(617) 499-5151
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
279792
MA
Other
Enumeration date
12/18/2008
Last updated
12/18/2008
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