Provider Demographics
NPI:1134847437
Name:EASTMAN, ERIKA (LSW)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:EASTMAN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4368 DRESSLER RD NW STE 103
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2776
Mailing Address - Country:US
Mailing Address - Phone:330-433-1300
Mailing Address - Fax:330-494-0828
Practice Address - Street 1:4368 DRESSLER RD NW STE 103
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2776
Practice Address - Country:US
Practice Address - Phone:330-433-1300
Practice Address - Fax:330-494-0828
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-22
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0035313Medicaid