Eastside Behavioral Medicine

Primary specialty

PsychologistTaxonomy code 103T00000X

License

602-967-118 Issued in WA

Legal business name

EASTSIDE BEHAVIORAL MEDICINE

Practice address

1601 114TH Ave SE
Suite 145
Bellevue, WA 98004-6950

Phone

(425) 454-3110

Fax

(425) 283-0486

NPI assigned

Feb 4, 2010

Last updated

Feb 4, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Darla Capetillo, PHDNPI 1639244866

Title

Owner

Phone

(425) 454-3110

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Darla V Capetillo, PH.D.

  • Clinical Psychologist
  • Seattle, WA
  • NPI 1639244866
  NPD (past) Authorized official
• Constance A Kehrer, PH.D.

  • Clinical Psychologist
  • Bellevue, WA
  • NPI 1851330716
  NPD (past)
• Cynthia Ann Mason, PHD

  • Clinical Psychologist
  • Bellevue, WA
  • NPI 1720270036
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1265241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265241600000",
    "number": "1952633737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 114TH AVE SE",
            "address_2": "SUITE 145",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980046950",
            "telephone_number": "425-454-3110",
            "fax_number": "425-283-0486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 114TH AVE SE",
            "address_2": "SUITE 145",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980046950",
            "telephone_number": "425-454-3110",
            "fax_number": "425-283-0486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTSIDE BEHAVIORAL MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-04",
        "last_updated": "2010-02-04",
        "status": "A",
        "authorized_official_last_name": "CAPETILLO",
        "authorized_official_first_name": "DARLA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "425-454-3110",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WA",
            "license": "602-967-118",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INDUSTRIES/MASON",
            "identifier": "0240031",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INDUSTRIES/CAPETILLO",
            "identifier": "0221560",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UBI",
            "identifier": "602967118",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Heather Easterly, DPT
• Eastern Scholar Acupuncture PLLC (Eastern Scholar Acupuncture)
• Deena Jo Eastern, MS
• Eastgate Family Medicine
• Eastside Anxiety PLLC
• Eastside Birth Center, PS
• Eastside Chiropractic Group a Professional Service Corporation
• Eastside Dermatology Inc PS
• Eastside Endocrinology and Diabetes, PS
• Eastside Family Medicine Clinic

• Psychologist in Bellevue, WA
• Providers in Bellevue, WA by specialty
• Psychologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.