Provider Demographics
NPI:1356493852
Name:EASTMAN, MARGOT (LCMHC)
Entity Type:Individual
Prefix:
First Name:MARGOT
Middle Name:
Last Name:EASTMAN
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2606 S ALBANY RD
Mailing Address - Street 2:
Mailing Address - City:CRAFTSBURY COMMON
Mailing Address - State:VT
Mailing Address - Zip Code:05827-9762
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:154 DUCHESS AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-5516
Practice Address - Country:US
Practice Address - Phone:802-334-6744
Practice Address - Fax:802-334-7455
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0000597101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1009108Medicaid