Provider Demographics
NPI:1467622472
Name:RICHARD HIGINBOTHAM PA
Entity Type:Organization
Organization Name:RICHARD HIGINBOTHAM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HIGINBOTHAM PA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:734-320-6940
Mailing Address - Street 1:3940 N FLAGLER DR
Mailing Address - Street 2:#201
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-4441
Mailing Address - Country:US
Mailing Address - Phone:734-320-6940
Mailing Address - Fax:
Practice Address - Street 1:614 NE JENSEN BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-4750
Practice Address - Country:US
Practice Address - Phone:772-225-1226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW8769261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health