Provider Demographics
NPI:1114690641
Name:BINGHAM, JUDITH CHRISTINE
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:CHRISTINE
Last Name:BINGHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:MT. VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10553
Mailing Address - Country:US
Mailing Address - Phone:914-613-0700
Mailing Address - Fax:914-383-3145
Practice Address - Street 1:265 WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:MT. VERNON
Practice Address - State:NY
Practice Address - Zip Code:10553
Practice Address - Country:US
Practice Address - Phone:914-613-0700
Practice Address - Fax:914-383-3145
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-30
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY344236-1163WA0400X, 163WC0400X, 163WP0808X, 163WP0809X
NY344284-1163WC0400X, 163WP0808X, 163WP0809X, 163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult