Provider Demographics
NPI:1689688327
Name:EASTLER, GERALDINE C (LICSW)
Entity Type:Individual
Prefix:MS
First Name:GERALDINE
Middle Name:C
Last Name:EASTLER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 THE HL
Mailing Address - Street 2:PHOEBE HART HOUSE
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-3736
Mailing Address - Country:US
Mailing Address - Phone:603-422-7700
Mailing Address - Fax:
Practice Address - Street 1:404 THE HL
Practice Address - Street 2:PHOEBE HART HOUSE
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-3736
Practice Address - Country:US
Practice Address - Phone:603-422-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80003776Medicaid
NHRE3776Medicare ID - Type Unspecified