Provider Demographics
NPI:1588606255
Name:BYNES, DAVID M (LCSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:BYNES
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 N TUCSON BLVD
Mailing Address - Street 2:SUITE 36
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716
Mailing Address - Country:US
Mailing Address - Phone:520-323-9835
Mailing Address - Fax:520-327-2342
Practice Address - Street 1:1601 N TUCSON BLVD
Practice Address - Street 2:SUITE 36
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716
Practice Address - Country:US
Practice Address - Phone:520-323-9835
Practice Address - Fax:520-327-2342
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW27461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ743494Medicaid
AZ743494Medicaid
Q32918Medicare UPIN