Provider Demographics
NPI:1174766588
Name:BINGHAM, ANDREW R (CASAC-T)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:R
Last Name:BINGHAM
Suffix:
Gender:M
Credentials:CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-3707
Mailing Address - Country:US
Mailing Address - Phone:212-864-4128
Mailing Address - Fax:212-864-7987
Practice Address - Street 1:931 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-3707
Practice Address - Country:US
Practice Address - Phone:212-864-4128
Practice Address - Fax:212-864-7987
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY19108101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)