Provider Demographics
NPI:1598830762
Name:HIGGINS, LISA A (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:563 SAGAMORE AVE
Mailing Address - Street 2:APT#3
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-5561
Mailing Address - Country:US
Mailing Address - Phone:603-501-0176
Mailing Address - Fax:
Practice Address - Street 1:563 SAGAMORE AVE APT 3
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5541
Practice Address - Country:US
Practice Address - Phone:603-501-0176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH10481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH99003227Medicaid
NH7706655Y0NH01OtherBHN
NH99003227Medicaid