Provider Demographics
NPI:1215079769
Name:BINGAMAN, CYNTHIA L (LBSW)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:L
Last Name:BINGAMAN
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:MS
Other - First Name:CYNTHIA
Other - Middle Name:L
Other - Last Name:BEVELHYMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LBSW
Mailing Address - Street 1:1485 S M-139
Mailing Address - Street 2:
Mailing Address - City:BENTON HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49022
Mailing Address - Country:US
Mailing Address - Phone:269-925-0585
Mailing Address - Fax:269-927-1326
Practice Address - Street 1:1485 S M-139
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022
Practice Address - Country:US
Practice Address - Phone:269-925-0585
Practice Address - Fax:269-927-1326
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802081699104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker