Active NPI
Vanessa Abigail Casillas, PSY.D.
- Clinical Psychologist
- Portland, OR
National Provider Identifier
1235432287
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2090
- Practice address
- 4920 N Interstate Ave
Portland, OR 97217-3653 - Phone
- (503) 215-3300
- Fax
- (503) 215-3350
- NPI assigned
- Dec 14, 2010
- Last updated
- Oct 14, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cognitive & Behavioral Psychologist | 103TB0200X | 2090 | OR | |
| Clinical Psychologist | 103TC0700X | 2090 | OR | Primary |
Addresses
Primary practice location
4920 N Interstate Ave
Portland, OR 97217-3653
Mailing address
PO Box 3158
Portland, OR 97208-3158
Phone (503) 215-6494
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500631879 | Medicaid | OR |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | vcasillas133980@oc.providencedirect.org |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2090 | OR | MD | Naturopath |
Interoperability endpoints
- vcasillas133980@oc.providencedirect.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1292284800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1602633600000",
"number": "1235432287",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3158",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972083158",
"telephone_number": "503-215-6494",
"fax_number": "503-215-6644"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4920 N INTERSTATE AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972173653",
"telephone_number": "503-215-3300",
"fax_number": "503-215-3350"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CASILLAS",
"first_name": "VANESSA",
"middle_name": "ABIGAIL",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-12-14",
"last_updated": "2020-10-14",
"certification_date": "2020-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "OR",
"license": "2090",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OR",
"license": "2090",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500631879",
"state": "OR"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "vcasillas133980@oc.providencedirect.org",
"affiliation": "N",
"address_1": "4920 N Interstate Ave",
"city": "Portland",
"state": "OR",
"country_code": "US",
"postal_code": "972173653",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.