MEDICARE: MRS. KIMBERLY MARIE HIGGINS LCSW, MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	44SC05199000	NJ

General Provider Information

NPI Number	:	1093826943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY MARIE HIGGINS LCSW, MSW

Provider Business Mailing Address
First Line	:	2146 REDWOOD DR
Second Line	:
City	:	SEA GIRT
State	:	NJ
Zip	:	08750-1106
Country	:	US
Telephone Number	:	732-974-2699
Fax Number	:

Provider Business Practice Location Address
First Line	:	2095 ROUTE 88
Second Line	:
City	:	BRICK
State	:	NJ
Zip	:	08724-3265
Country	:	US
Telephone Number	:	732-701-0440
Fax Number	:	732-701-0419

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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