Provider Demographics
NPI:1578532461
Name:EASTMAN, BETTY JAYNE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:JAYNE
Last Name:EASTMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 BELLES COVE DR
Mailing Address - Street 2:APT G
Mailing Address - City:POQUOSON
Mailing Address - State:VA
Mailing Address - Zip Code:23662-1567
Mailing Address - Country:US
Mailing Address - Phone:757-868-0072
Mailing Address - Fax:757-868-0087
Practice Address - Street 1:360 WYTHE CREEK RD
Practice Address - Street 2:SUITE C
Practice Address - City:POQUOSON
Practice Address - State:VA
Practice Address - Zip Code:23662-1975
Practice Address - Country:US
Practice Address - Phone:757-868-0072
Practice Address - Fax:757-868-0087
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040046801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010172314Medicaid
VA428878OtherTRICARE
VA356288OtherBLUE CROSS BLUE SHIELD
VA356288OtherBLUE CROSS BLUE SHIELD