Provider Demographics
NPI:1902243637
Name:HIGGINS, JUSTIN (LCSW-R)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:HIGGINS
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 WHEATFIELD ST STE 28
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-7034
Mailing Address - Country:US
Mailing Address - Phone:716-202-2900
Mailing Address - Fax:
Practice Address - Street 1:525 WHEATFIELD ST STE 28
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-7034
Practice Address - Country:US
Practice Address - Phone:716-202-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-04
Last Update Date:2021-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0864591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical