Provider Demographics
NPI:1982487476
Name:BINGHAM, EMILIA (LCSW)
Entity Type:Individual
Prefix:
First Name:EMILIA
Middle Name:
Last Name:BINGHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 S HUNTINGTON AVE APT 22
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-4762
Mailing Address - Country:US
Mailing Address - Phone:208-481-7678
Mailing Address - Fax:
Practice Address - Street 1:240 MEDFORD ST
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:MA
Practice Address - Zip Code:02129-1930
Practice Address - Country:US
Practice Address - Phone:617-241-0209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALCSW2295121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical