Provider Demographics
NPI:1770684268
Name:BERMINGHAM, WILLIAM M (LCSW-R)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:M
Last Name:BERMINGHAM
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4985 HARLEM ROAD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226
Mailing Address - Country:US
Mailing Address - Phone:716-839-0500
Mailing Address - Fax:716-839-0523
Practice Address - Street 1:4985 HARLEM ROAD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226
Practice Address - Country:US
Practice Address - Phone:716-839-0500
Practice Address - Fax:716-839-0523
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0409351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB9025Medicaid