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General NPI Number Information
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NPI Number | 1700428034
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Entity Type | Individual
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Provider Name | ROBERTA S HIGGINBOTHAM LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/08/2019
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Last Update Date | 10/08/2019
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Provider Practice Location Address
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Address Line | 421 LITHIA PINECREST RD
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City | BRANDON
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State | FL
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Zip | 33511-6138
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Country | US
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Telephone | 813-315-8648
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4643
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City | PLANT CITY
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State | FL
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Zip | 33563-0029
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Country | US
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Telephone | 813-763-1783
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW11273
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License Number State | FL
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