Provider Demographics
NPI:1053416842
Name:HIGGINS, REGINA (EDD)
Entity type:Individual
Prefix:DR
First Name:REGINA
Middle Name:
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:DR
Other - First Name:REGINA
Other - Middle Name:
Other - Last Name:O'CONNELL-HIGGINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:EDD
Mailing Address - Street 1:ONE SALEM GREEN
Mailing Address - Street 2:SUITE 555
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970
Mailing Address - Country:US
Mailing Address - Phone:978-968-9528
Mailing Address - Fax:888-765-8406
Practice Address - Street 1:ONE SALEM GREEN
Practice Address - Street 2:SUITE 555
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970
Practice Address - Country:US
Practice Address - Phone:978-968-9528
Practice Address - Fax:888-765-8406
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4087103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
713018OtherTUFTS
MAW03997OtherBCBS
MAW03997Medicare PIN