Provider Demographics
NPI:1891090486
Name:BINGAMAN, DUSTIN DEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:DEL
Last Name:BINGAMAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:PUNXSUTAWNEY
Mailing Address - State:PA
Mailing Address - Zip Code:15767-2605
Mailing Address - Country:US
Mailing Address - Phone:814-938-1830
Mailing Address - Fax:814-938-1831
Practice Address - Street 1:240 W MAHONING ST
Practice Address - Street 2:
Practice Address - City:PUNXSUTAWNEY
Practice Address - State:PA
Practice Address - Zip Code:15767-1919
Practice Address - Country:US
Practice Address - Phone:814-938-1830
Practice Address - Fax:814-938-1831
Is Sole Proprietor?:No
Enumeration Date:2011-01-13
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS018282103T00000X, 103T00000X
PACW017942104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1028487340001Medicaid