Provider Demographics
NPI:1124294285
Name:EASTMAN, RUTH MICHELLE (MS CLINICAL PSYCHOLO)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:MICHELLE
Last Name:EASTMAN
Suffix:
Gender:F
Credentials:MS CLINICAL PSYCHOLO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8352 CHURCH ST
Mailing Address - Street 2:SUITE #
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-4449
Mailing Address - Country:US
Mailing Address - Phone:408-848-6511
Mailing Address - Fax:408-848-2099
Practice Address - Street 1:8352 CHURCH ST
Practice Address - Street 2:SUITE #
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-4449
Practice Address - Country:US
Practice Address - Phone:408-848-6511
Practice Address - Fax:408-848-2099
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 51075106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist