Provider Demographics
NPI:1396185955
Name:HIGGINS, AMY MICHELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MICHELLE
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15339 SATICOY ST
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-3345
Mailing Address - Country:US
Mailing Address - Phone:562-833-9923
Mailing Address - Fax:
Practice Address - Street 1:3910 OAKWOOD AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-3413
Practice Address - Country:US
Practice Address - Phone:323-953-7390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW36169101YM0800X
CALCSW722841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health