Provider Demographics
NPI:1841427689
Name:EASTON, ELIZABETH SUSAN (LCSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SUSAN
Last Name:EASTON
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 1:42 MALLETT DR
Mailing Address - Street 2:SUITE 22
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032-1355
Mailing Address - Country:US
Mailing Address - Phone:207-865-1101
Mailing Address - Fax:
Practice Address - Street 1:42 MALLETT DR
Practice Address - Street 2:SUITE 2
Practice Address - City:FREEPORT
Practice Address - State:ME
Practice Address - Zip Code:04032-1355
Practice Address - Country:US
Practice Address - Phone:207-865-1101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-19
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC128781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME0020436Medicare PIN