Provider Demographics
NPI:1134800105
Name:BINGHAM, LATOYA A (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:LATOYA
Middle Name:A
Last Name:BINGHAM
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4316 LINDENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-2052
Mailing Address - Country:US
Mailing Address - Phone:630-791-0498
Mailing Address - Fax:
Practice Address - Street 1:4316 LINDENWOOD DR
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-2052
Practice Address - Country:US
Practice Address - Phone:630-791-0498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0238571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical