Provider Demographics
NPI:1942333778
Name:EASTMAN, BRENDA J
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:J
Last Name:EASTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 GARDNERS NECK RD
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02777-3105
Mailing Address - Country:US
Mailing Address - Phone:800-788-6084
Mailing Address - Fax:508-674-8730
Practice Address - Street 1:436 GARDNERS NECK RD
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:MA
Practice Address - Zip Code:02777-3105
Practice Address - Country:US
Practice Address - Phone:800-788-6084
Practice Address - Fax:508-674-8730
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIELI0044171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIBE34152OtherLEAD INSPECTOR