Provider Demographics
NPI:1922309467
Name:U.S. DEPARTMENT OF VETERAN AFFAIRS
Entity Type:Organization
Organization Name:U.S. DEPARTMENT OF VETERAN AFFAIRS
Other - Org Name:VET CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:TEAM LEADER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:EASTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYCHOLOGIST
Authorized Official - Phone:802-295-2908
Mailing Address - Street 1:11337 SW IRONWOOD LOOP
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-4200
Mailing Address - Country:US
Mailing Address - Phone:503-521-6146
Mailing Address - Fax:
Practice Address - Street 1:222 HOLIDAY DR
Practice Address - Street 2:
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05001-2043
Practice Address - Country:US
Practice Address - Phone:802-295-2908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00049914251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health