Provider Demographics
NPI:1588781231
Name:BINGHAM, DONOVAN EMANUEL (LIC PSYCHIATRICTECH)
Entity type:Individual
Prefix:
First Name:DONOVAN
Middle Name:EMANUEL
Last Name:BINGHAM
Suffix:
Gender:M
Credentials:LIC PSYCHIATRICTECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2712 MISSION ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-3104
Mailing Address - Country:US
Mailing Address - Phone:415-401-2750
Mailing Address - Fax:415-401-2774
Practice Address - Street 1:2712 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3104
Practice Address - Country:US
Practice Address - Phone:415-401-2750
Practice Address - Fax:415-401-2774
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT23673167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
8126OtherCBHS INTERNAL USE ONLY-COMMERCIAL NUMBER
8126OtherSFGH INTERNAL USE ONLY