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Organization
EASTSIDE BEHAVIORAL MEDICINE
Active
Organization
EASTSIDE BEHAVIORAL MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DARLA CAPETILLO PHD (OWNER)
(425) 454-3110
Entity
Organization
Contact information
Practice address
1601 114TH AVE SE, SUITE 145, BELLEVUE, WA 98004-6950
(425) 454-3110
(425) 283-0486
Mailing address
1601 114TH AVE SE, SUITE 145, BELLEVUE, WA 98004-6950
(425) 454-3110
(425) 283-0486
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
602-967-118
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0221560
LABOR AND INDUSTRIES/CAPETILLO
WA
01
—
0240031
LABOR AND INDUSTRIES/MASON
WA
01
—
602967118
UBI
WA
Enumeration date
02/04/2010
Last updated
02/04/2010
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