Provider Demographics
NPI:1396850509
Name:HIGINBOTHAM, HOLLY (PSYD)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:HIGINBOTHAM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1957 OLD ROUTE 9
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:MA
Mailing Address - Zip Code:01270-9399
Mailing Address - Country:US
Mailing Address - Phone:413-684-3724
Mailing Address - Fax:
Practice Address - Street 1:741 NORTH ST
Practice Address - Street 2:BRIEN FAMILY CENTER
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4109
Practice Address - Country:US
Practice Address - Phone:413-447-2145
Practice Address - Fax:413-447-3245
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7711103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA31709OtherHEALTH NEW ENGLAND
MAW06193OtherBCBSMA
MA472277OtherTUFTS
MA1854330Medicaid
MA473816000OtherMAGELLAN
MA473816000OtherMAGELLAN