Provider Demographics
NPI:1902377641
Name:BINGHAM, DAVID A (MA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:BINGHAM
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 MAIN ST STE 207E
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-3057
Mailing Address - Country:US
Mailing Address - Phone:802-266-4983
Mailing Address - Fax:
Practice Address - Street 1:167 MAIN ST STE 207E
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-3057
Practice Address - Country:US
Practice Address - Phone:802-266-4983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-06
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0118746101YM0800X
VT097.0113092101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional