Provider Demographics
NPI:1942368675
Name:EASTIN, CRISTINE L (PHD LCSW)
Entity Type:Individual
Prefix:DR
First Name:CRISTINE
Middle Name:L
Last Name:EASTIN
Suffix:
Gender:F
Credentials:PHD LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6417 ODANA RD
Mailing Address - Street 2:CORNERSTONE MENTAL HEALTH
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719
Mailing Address - Country:US
Mailing Address - Phone:608-271-9986
Mailing Address - Fax:608-271-9988
Practice Address - Street 1:6417 ODANA RD
Practice Address - Street 2:CORNERSTONE MENTAL HEALTH
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719
Practice Address - Country:US
Practice Address - Phone:608-271-9986
Practice Address - Fax:608-271-9988
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17801231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39201300Medicaid