Provider Demographics
NPI:1881209096
Name:BINGHAM, DARREN
Entity Type:Individual
Prefix:
First Name:DARREN
Middle Name:
Last Name:BINGHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 SOUTHWICK DR
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-2254
Mailing Address - Country:US
Mailing Address - Phone:708-747-2655
Mailing Address - Fax:
Practice Address - Street 1:4801 SOUTHWICK DR
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-2254
Practice Address - Country:US
Practice Address - Phone:708-747-2655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker