Provider Demographics
NPI:1316082258
Name:HIGGINS, KENT ERIC (PHD)
Entity type:Individual
Prefix:DR
First Name:KENT
Middle Name:ERIC
Last Name:HIGGINS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 COLUMBIA DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-3106
Mailing Address - Country:US
Mailing Address - Phone:413-256-0109
Mailing Address - Fax:413-794-9490
Practice Address - Street 1:16 NORTH HADLEY ROAD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-1905
Practice Address - Country:US
Practice Address - Phone:413-374-8194
Practice Address - Fax:413-794-9490
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6563103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA7544OtherHEALTHNET PROVIDER #
MA1202847Medicaid
MA7544OtherHEALTHNET PROVIDER #