Provider Demographics
NPI:1154435931
Name:HIGGINS, RICHARD JAY JR (PSYD)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:JAY
Last Name:HIGGINS
Suffix:JR
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:694 COUNTY ROUTE 5
Mailing Address - Street 2:
Mailing Address - City:EAST CHATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12060-2822
Mailing Address - Country:US
Mailing Address - Phone:518-392-5033
Mailing Address - Fax:
Practice Address - Street 1:694 COUNTY ROUTE 5
Practice Address - Street 2:
Practice Address - City:EAST CHATHAM
Practice Address - State:NY
Practice Address - Zip Code:12060-2822
Practice Address - Country:US
Practice Address - Phone:518-605-2223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014615103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVL4491Medicare ID - Type Unspecified