Provider Demographics
NPI:1295611085
Name:EASTMAN-JEPSON, ELIZA
Entity type:Individual
Prefix:
First Name:ELIZA
Middle Name:
Last Name:EASTMAN-JEPSON
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 1:22 FITZWATERTOWN RD UNIT D10
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-3047
Mailing Address - Country:US
Mailing Address - Phone:215-200-2316
Mailing Address - Fax:
Practice Address - Street 1:22 FITZWATERTOWN RD UNIT D10
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-3047
Practice Address - Country:US
Practice Address - Phone:215-200-2316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW143134104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker