Provider Demographics
NPI:1124130521
Name:EASTMAN, KATHRYN K (LMFT)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:K
Last Name:EASTMAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 WASHINGTON ST
Mailing Address - Street 2:P.O. BOX # 255
Mailing Address - City:CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03818-6031
Mailing Address - Country:US
Mailing Address - Phone:603-447-3770
Mailing Address - Fax:603-447-3247
Practice Address - Street 1:45 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03818-6031
Practice Address - Country:US
Practice Address - Phone:603-447-3770
Practice Address - Fax:603-447-3247
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH62106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH14Y001309NH02OtherBEHAVIORAL HEALTH
NH30424397Medicaid