Provider Demographics
NPI:1083890578
Name:HIGGINS, PHILIP CHARLES (LICSW)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:CHARLES
Last Name:HIGGINS
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:298A HIGHLAND AVE
Mailing Address - Street 2:APT. 3
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-3223
Mailing Address - Country:US
Mailing Address - Phone:917-626-5391
Mailing Address - Fax:
Practice Address - Street 1:19 FRONT ST
Practice Address - Street 2:STE 202
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3795
Practice Address - Country:US
Practice Address - Phone:917-626-5391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1140851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical