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General NPI Number Information
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NPI Number | 1467622472
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Entity Type | Organization
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Legal Business Name | RICHARD HIGINBOTHAM PA
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Dates
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Enumeration Date | 03/05/2008
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Last Update Date | 03/05/2008
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Provider Practice Location Address
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Address Line | 614 NE JENSEN BEACH BLVD
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City | JENSEN BEACH
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State | FL
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Zip | 34957-4750
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Country | US
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Telephone | 772-225-1226
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Fax |
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Provider Business Mailing Address
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Address Line | 3940 N FLAGLER DR #201
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City | WEST PALM BEACH
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State | FL
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Zip | 33407-4441
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Country | US
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Telephone | 734-320-6940
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICHARD HIGINBOTHAM PA
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Credential | LCSW
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Telephone | 734-320-6940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | SW8769
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License Number State | FL
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