Provider Demographics
NPI:1134571367
Name:BINGMAN, DARRAH
Entity type:Individual
Prefix:
First Name:DARRAH
Middle Name:
Last Name:BINGMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9734 BLUE ISLE BAY
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-2889
Mailing Address - Country:US
Mailing Address - Phone:740-517-0460
Mailing Address - Fax:
Practice Address - Street 1:9734 BLUE ISLE BAY
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33076-2889
Practice Address - Country:US
Practice Address - Phone:740-517-0460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-12
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9575103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPY9575OtherLICENSE