Provider Demographics
NPI:1104851344
Name:HIGGINS, GARY ARTHUR (LCSW)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:ARTHUR
Last Name:HIGGINS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:50 WATERBURY RD
Mailing Address - Street 2:2C
Mailing Address - City:PROSPECT
Mailing Address - State:CT
Mailing Address - Zip Code:06712-1258
Mailing Address - Country:US
Mailing Address - Phone:203-769-1021
Mailing Address - Fax:203-768-1021
Practice Address - Street 1:50 WATERBURY RD
Practice Address - Street 2:2C
Practice Address - City:PROSPECT
Practice Address - State:CT
Practice Address - Zip Code:06712-1258
Practice Address - Country:US
Practice Address - Phone:203-768-1021
Practice Address - Fax:203-768-1021
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0042121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004188365Medicaid
CT004188365Medicaid