MAGNOLIA PSYCHIATRY, LLC (NPI# 1003346594) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003346594 |
| Entity Type | Organization |
| Organization Name | MAGNOLIA PSYCHIATRY, LLC |
| Practice Address |
12729 Northup Way Ste 6 Bellevue WA 98005-1935 |
| Mailing Address |
Po Box 7239 Bellevue WA 98008-1239 |
| Practice Telephone | 4254671000 |
| Practice Fax Number | 4254670100 |
| Mailing Telephone | 4254671000 |
| Mailing Fax Number | 4254670100 |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2019-04-17 |
| Authorized Official Name | MARC DAVID PELLICCIARO (PSYCHIATRIST) |
| Authorized Official Telephone | 4254671000 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084P0802X |
Psychiatry & Neurology Specialization: Addiction Psychiatry |
MD00036813 | WA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | WASHINGTON STATE MEDICAL LICENSE | MD00036813 | 01 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | MAGNOLIA PSYCHIATRY, LLC | 12729 Northup Way, Suite 6, Bellevue, WA 98005-1935 |
| Street Address |
12729 NORTHUP WAY STE 6 |
| City | BELLEVUE |
| State | WA |
| Zip Code | 98005-1935 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962575951 | Marc D Pellicciaro | Psychiatry & Neurology | 12729 Northup Way Ste 6, Bellevue, WA 98005-1935 | 2006-11-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679194161 | Move Well, Be Well Pllc | Clinic/Center | 11900 Ne 1st Street, Suite 3106, Bellevue, WA 98005 | 2020-05-06 |
| 1649899410 | Wen-fang Ku | Acupuncturist | 13555 Bel-red Rd, Suite 110, Bellevue, WA 98005 | 2020-04-13 |
| 1558901801 | Janelle Morris | Behavior Technician | 12729 Northup Way, Suite 9, Bellevue, WA 98005 | 2020-01-14 |
| 1912467234 | Amanda Gallardo | Behavior Technician | 13333 Bel Rd Suite 100, Bellevue, WA 98005 | 2019-03-22 |
| 1639637903 | Oxana I Varvaryuk | Massage Therapist | 606 120th Ave Ne, Suite D104, Bellevue, WA 98005 | 2019-03-06 |
| 1609346246 | Bhavjit Kaur Mangat | Optometrist | 1808 Richards Rd Suite 110, Bellevue, WA 98005 | 2018-11-27 |
| 1386138907 | Amanda Frances Ellis | Dietitian, Registered | 915 118th Ave Se, Attention Alecia Johnson, Ret Physica, Suite 110, Bellevue, WA 98005 | 2018-06-18 |
| 1093227654 | Jinda Chaijinda | Naturopath | 13353 Bel-red Road Suite A105, Bellevue, WA 98005 | 2017-11-03 |
| 1962927038 | Laura Jo Zuker Olsen | Optometrist | 13401 Bel-red Rd Ne, Suite A4 - Bellevue Vision Clinic, Bellevue, WA 98005 | 2017-08-09 |
| 1336678697 | Yong Huang | Massage Therapist | 12505 Bel-red Road, Suite 188, Bellevue, WA 98005 | 2017-06-08 |
| Find all providers in zip 98005 | ||||
| Taxonomy Code | 2084P0802X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Addiction Psychiatry |
| Addiction Psychiatry is a subspecialty of psychiatry that focuses on evaluation and treatment of individuals with alcohol, drug, or other substance-related disorders, and of individuals with dual diagnosis of substance-related and other psychiatric disorders. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609915685 | Howard Berryman Edwards | Psychiatry & Neurology | 14205 Se 36th St, 100, Bellevue, WA 98006-1596 | 2007-02-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003236761 | Daniel Magliozzi | Psychiatry & Neurology | Va American Lake 9600 Veterans Drive Southwest, Tacoma, WA 98493-6560 | 2014-04-22 |
| 1649461740 | Center for Assessment & Therapy Services Ps | Psychiatry & Neurology | 10634 E Riverside Dr, Suite 130, Bothell, WA 98011-3757 | 2007-08-05 |
| 1962583609 | Craig Jaffe | Psychiatry & Neurology | 216 James St, Seattle, WA 98104-2212 | 2006-10-18 |
| 1063451805 | Daniel Eugene Wolf | Psychiatry & Neurology | 6537 35th Ave Sw, Seattle, WA 98126-3005 | 2006-06-06 |
| 1235765280 | Pacific Phoenix Group Pllc | Psychiatry & Neurology | 601 Main St Ste 505, Vancouver, WA 98660-3414 | 2020-03-20 |
| 1215179585 | Alexandra March Bright | Psychiatry & Neurology | 12360 Lake City Way Ne, Suite 200, Seattle, WA 98125-5447 | 2009-04-01 |
| 1780851261 | Fred Adams Montgomery | Psychiatry & Neurology | 215 S 11th Ave, D, Yakima, WA 98902-3255 | 2008-05-13 |
| 1831227065 | Richard K Ries | Psychiatry & Neurology | 325 9th Ave, Seattle, WA 98104-2420 | 2007-03-01 |
| 1518064955 | Rosa Frances Merino | Psychiatry & Neurology | Madigan Army Medical Center 9040 Jackson Avenue, Tacoma, WA 98431-0001 | 2006-09-20 |
| 1215049176 | George Timothy Bondurant | Psychiatry & Neurology | 1660 S Columbian Way, Veterans Affairs Puget Sound Health Care System, Seattle, WA 98108-1532 | 2006-08-31 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.