Provider Demographics
NPI:1407266927
Name:EASTMAN, SHARON
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:EASTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:
Other - Last Name:PISIAKOWSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 554
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06035-0554
Mailing Address - Country:US
Mailing Address - Phone:860-895-3059
Mailing Address - Fax:
Practice Address - Street 1:15R HARTFORD AVE STE CD
Practice Address - Street 2:
Practice Address - City:GRANBY
Practice Address - State:CT
Practice Address - Zip Code:06035-2342
Practice Address - Country:US
Practice Address - Phone:860-895-3059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0086151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical