Provider Demographics
NPI:1922022706
Name:HIGGINS, LAURIE ANNE (MS, RD, LDN, CDE)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:ANNE
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:MS, RD, LDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 HAZELMERE RD
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-1423
Mailing Address - Country:US
Mailing Address - Phone:617-325-5516
Mailing Address - Fax:
Practice Address - Street 1:1 JOSLIN PL
Practice Address - Street 2:PEDAITRICS, UNIT 3
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5306
Practice Address - Country:US
Practice Address - Phone:617-309-2654
Practice Address - Fax:617-309-2451
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA278133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMT017601Medicaid