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General NPI Number Information
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NPI Number | 1932434420
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Entity Type | Organization
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Legal Business Name | CORNERSTONE MENTAL HEALTH ASSOCIATES
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Dates
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Enumeration Date | 10/16/2009
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Last Update Date | 10/16/2009
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Provider Practice Location Address
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Address Line | 6417 ODANA RD #C
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City | MADISON
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State | WI
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Zip | 53719
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Country | US
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Telephone | 608-271-9986
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Fax | 608-271-9988
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Provider Business Mailing Address
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Address Line | 6417 ODANA RD #C
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City | MADISON
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State | WI
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Zip | 53719
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Country | US
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Telephone | 608-271-9986
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Fax | 608-271-9988
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Authorized Official
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Title or Position | CO-OWNER/PARTNER
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Name | DR. DAVID L. EASTIN
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Credential | CL/CO PSYCHOLOGIST (
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Telephone | 608-271-9986
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1477
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1780-123
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License Number State | WI
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