Individual ProviderLarry HigginbottomSocial WorkerBehavioral Health & Social Service ProvidersPractice Address184 Dudley St, Suite 107 Ll, Roxbury, MA 02119-2561(617) 442-2002PECOS EnrollmentBased on the most recent information from CMS, provider Larry Higginbottom does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records today at 12:07 PM.Profile DetailsProvider ID1003062688Provider TypeIndividualFull NameHigginbottom, LarryCredentialMSW / LCSWGenderMaleSole ProprietorYesEnumeration Date8/14/2008Last Updated8/14/2008Contact InformationPractice LocationPractice Address184 Dudley St, Suite 107 Ll, Roxbury, MA 02119-2561Phone(617) 442-2002Fax(617) 442-4002Mailing LocationMailing Address184 Dudley St, Suite 107 Ll, Roxbury, MA 02119-2561Phone(617) 442-2002Fax(617) 442-4002Provider TaxonomiesCodeDescriptionLicenseCode1041C0700XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicense2030131Massachusetts