Provider Demographics
NPI:1356023097
Name:EASTMAN, JONATHAN PAUL (LMFT)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:PAUL
Last Name:EASTMAN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 NE 118TH ST
Mailing Address - Street 2:
Mailing Address - City:BISCAYNE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33161-6439
Mailing Address - Country:US
Mailing Address - Phone:305-588-4796
Mailing Address - Fax:
Practice Address - Street 1:3325 HOLLYWOOD BLVD STE 301
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6926
Practice Address - Country:US
Practice Address - Phone:954-925-1113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT4627106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist