Healthcare Provider Details

I. General information

NPI: 1467622472
Provider Name (Legal Business Name): RICHARD HIGINBOTHAM PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2008
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 NE JENSEN BEACH BLVD
JENSEN BEACH FL
34957-4750
US

IV. Provider business mailing address

3940 N FLAGLER DR #201
WEST PALM BEACH FL
33407-4441
US

V. Phone/Fax

Practice location:
  • Phone: 772-225-1226
  • Fax:
Mailing address:
  • Phone: 734-320-6940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberSW8769
License Number StateFL

VIII. Authorized Official

Name: RICHARD HIGINBOTHAM PA
Title or Position: PRESIDENT
Credential: LCSW
Phone: 734-320-6940