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General NPI Number Information
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NPI Number | 1003706706
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Entity Type | Individual
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Provider Name | CHARLES J. BERMINGHAM PHD
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Gender | Male
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Dates
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Enumeration Date | 07/07/2025
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 209 E WASHINGTON ST
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City | IOWA CITY
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State | IA
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Zip | 52240-3909
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Country | US
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Telephone | 319-849-5069
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Fax |
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Provider Business Mailing Address
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Address Line | 1045 20TH AVE
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City | CORALVILLE
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State | IA
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Zip | 52241-1342
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Country | US
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Telephone | 815-978-7849
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 088621
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License Number State | IA
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