| Doctor Name: | LARRY HIGGINBOTTOM |
| NPI Number: | 1003062688 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MSW / LCSW |
| License Number: | 2030131 |
| Business Practice Address: | 184 Dudley St Suite 107 Ll Roxbury, MA - 021192561 |
| Business Phone Number: | 6174422002 |
| Business Fax Number: | 6174424002 |
| Mailing Address: | 184 Dudley St, Suite 107 Ll ROXBURY |
| State: | MA |
| Postal Code: | 021192561 |
| Phone Number: | 6174422002 |
| Fax Number: | 6174424002 |
| NPI Enumeration Date: | 08/14/2008 |
| NPI Last Update Date: | 08/14/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 2030131 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |