Provider Demographics
NPI:1578532461
Name:EASTMAN, BETTY JAYNE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:JAYNE
Last Name:EASTMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 WYTHE CREEK RD STE C
Mailing Address - Street 2:
Mailing Address - City:POQUOSON
Mailing Address - State:VA
Mailing Address - Zip Code:23662-1926
Mailing Address - Country:US
Mailing Address - Phone:757-868-0072
Mailing Address - Fax:757-868-0087
Practice Address - Street 1:370 WYTHE CREEK RD STE C
Practice Address - Street 2:
Practice Address - City:POQUOSON
Practice Address - State:VA
Practice Address - Zip Code:23662-1926
Practice Address - Country:US
Practice Address - Phone:757-868-0072
Practice Address - Fax:757-868-0087
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040046801041C0700X
VA9040004680103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAGC1022Medicaid
VA356288OtherBLUE CROSS BLUE SHIELD
VA428878OtherTRICARE
VA010172314Medicaid