Active NPI
Raffael Boccamazzo
- Clinical Psychologist
- Seattle, WA
National Provider Identifier
1013357359
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PY60835920
- Practice address
- 6040 California Ave SW Ste C
Seattle, WA 98136-1684 - Phone
- (206) 880-1721
- NPI assigned
- Jul 1, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PY60835920 | WA | Primary |
Addresses
Primary practice location
6040 California Ave SW Ste C
Seattle, WA 98136-1684
Mailing address
6040 California Ave SW Ste C
Seattle, WA 98136-1684
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY60835920 | WA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1372636800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1637625600000",
"number": "1013357359",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6040 CALIFORNIA AVE SW STE C",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981361684"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6040 CALIFORNIA AVE SW STE C",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981361684",
"telephone_number": "206-880-1721"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOCCAMAZZO",
"first_name": "RAFFAEL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-07-01",
"last_updated": "2021-11-23",
"certification_date": "2021-11-23",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WA",
"license": "PY60835920",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Seattle, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.