Provider Demographics
NPI:1285891689
Name:HIGHAM, JOHN DAVID (MA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
Last Name:HIGHAM
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 2668
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:PA
Mailing Address - Zip Code:17724-8626
Mailing Address - Country:US
Mailing Address - Phone:570-295-1638
Mailing Address - Fax:570-673-8814
Practice Address - Street 1:RR 2 BOX 2668
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:PA
Practice Address - Zip Code:17724-8626
Practice Address - Country:US
Practice Address - Phone:570-295-1638
Practice Address - Fax:570-673-8814
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006125L103T00000X, 103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities