Provider Demographics
NPI:1265609887
Name:BETTY EASTMAN LCSW AND ASSOCIATES INC
Entity type:Organization
Organization Name:BETTY EASTMAN LCSW AND ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:EASTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:757-868-0072
Mailing Address - Street 1:200 CITY HALL AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:POQUOSON
Mailing Address - State:VA
Mailing Address - Zip Code:23662-1985
Mailing Address - Country:US
Mailing Address - Phone:757-868-0072
Mailing Address - Fax:
Practice Address - Street 1:200 CITY HALL AVE
Practice Address - Street 2:SUITE E
Practice Address - City:POQUOSON
Practice Address - State:VA
Practice Address - Zip Code:23662-1985
Practice Address - Country:US
Practice Address - Phone:757-868-0072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040046801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA428878OtherTRICARE
VA356288OtherBLUE CROSS BLUE SHIELD
VA356288OtherBLUE CROSS BLUE SHIELD