TATJANA DERETIC (NPI# 1760418560) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760418560 |
| Entity Type | Individual |
| Full Name | TATJANA DERETIC |
| Credential | M.D. |
| Practice Address |
1400 112th Ave Se Ste. 100 Bellevue WA 98004-6901 |
| Practice Telephone | 4252217427 |
| Practice Fax Number | 4255026092 |
| Mailing Telephone | 4252217427 |
| Mailing Fax Number | 4255026092 |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2015-02-26 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
MD00043497 | WA | Allopathic & Osteopathic Physicians |
| Y | 2084P0804X |
Psychiatry & Neurology Specialization: Child & Adolescent Psychiatry |
MD00043497 | WA | Allopathic & Osteopathic Physicians |
| Street Address |
1400 112TH AVE SE STE. 100 |
| City | BELLEVUE |
| State | WA |
| Zip Code | 98004-6901 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508392929 | Equilibrium PCs, Pllc | Psychologist | 1400 112th Ave Se, Suite 205, Bellevue, WA 98004-6901 | 2017-05-04 |
| 1881066652 | Karla Garcia | Social Worker | 1400 112th Ave Se, Suite 100, Bellevue, WA 98004-6901 | 2015-10-20 |
| 1417328691 | Tessa Nicole Cooke | Counselor | 1400 112th Ave Se, Ste. 100 #35, Bellevue, WA 98004-6901 | 2015-10-13 |
| 1437540788 | Patti Davis Counseling | Community/Behavioral Health | 1400 112th Ave Se, Cedar Building Suite 202, Bellevue, WA 98004-6901 | 2015-02-09 |
| 1962801811 | Linda Mcgarvey | Counselor | 1400 112th Ave Se, Suite 100, Bellevue, WA 98004-6901 | 2014-08-16 |
| 1255742896 | Michael Keegan | Counselor | 1400 112th Ave Se, Ste 202, Bellevue, WA 98004-6901 | 2014-05-16 |
| 1003244948 | Jessica Kicha | Counselor | 1400 112th Ave Se, Suite 100, Bellevue, WA 98004-6901 | 2013-10-30 |
| 1407291578 | Shannon Marie Dickson | Specialist | 1400 112th Ave Se, Suite 100, Bellevue, WA 98004-6901 | 2013-05-02 |
| 1376892711 | Susan Ross | Social Worker | 1400 112th Ave Se, Suite 100, Bellevue, WA 98004-6901 | 2012-08-30 |
| 1467718890 | Adriana Prengler | Counselor | 1400 112th Ave Se, Suite 100, Bellevue, WA 98004-6901 | 2012-04-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306458328 | Geneva Paula Hoskins-dorsey | Nurse Practitioner | 11120 Ne 33rd Place, Suite 202, Bellevue, WA 98004 | 2020-08-20 |
| 1720553613 | Christine Eyler | Pediatrics | Bellevue Pediatrics, C & C Medical Associates, 1940 116th Ave Ne, Ste 200, Bellevue, WA 98004 | 2018-10-08 |
| 1437634730 | Hazelden Betty Ford Foundation | Clinic/Center | 1231 116th Ave. Ne Suite 410, Bellevue, WA 98004 | 2018-10-02 |
| 1356827828 | Seattle Spine Group, Pllc | Orthopaedic Surgery | 1220 116th Ave Ne Ste 102, Bellevue, WA 98004 | 2018-07-17 |
| 1669989216 | Atsuko Nakajima | Acupuncturist | 2223 112th Ave. Ne, Ste 201, Bellevue, WA 98004 | 2018-01-04 |
| 1740794718 | Radka Chapin Counseling, LLC | Clinic/Center | 1611 116th Ave Ne Ste 119, Bellevue, WA 98004 | 2017-11-28 |
| 1962912105 | Cuyler Ann Simmons | Counselor | 3805 108th Ave Ne Ste 204, Bellevue, WA 98004 | 2017-10-02 |
| 1639690357 | Nicolas Lopez-montalvo | Behavioral Analyst | 3003 Northup Way Suite 200, Bellevue, WA 98004 | 2017-07-03 |
| 1124579537 | Matthew Thomas Haley | Pharmacist | 107 Bellevue Way, Se, Bellevue, WA 98004 | 2016-10-20 |
| 1649727348 | Kelsey Tanaka | Nurse Practitioner | 400- 108th Ave Ne, Suite 100, Bellevue, WA 98004 | 2016-09-10 |
| Find all providers in zip 98004 | ||||
| Taxonomy Code | 2084P0804X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Child & Adolescent Psychiatry |
| Child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710223896 | Jack Raskin | Psychiatry & Neurology | 2624 161st Ave Se, Bellevue, WA 98008-5424 | 2012-12-18 |
| 1306000898 | Amy Lazar | Psychiatry & Neurology | 11820 Northup Way Ste E200, Bellevue, WA 98005-1966 | 2008-07-14 |
| 1497883326 | John Creighton Rose | Psychiatry & Neurology | 14030 Ne 24th St Ste 104, Bellevue, WA 98007-3731 | 2007-03-01 |
| 1023265188 | Romelia Perez | Psychiatry & Neurology | 1611 116th Ave Ne, Suite 132, Bellevue, WA 98004-3045 | 2008-08-20 |
| 1134385719 | Alicia Grattan Jorgenson | Psychiatry & Neurology | 1135 116th Ave Ne, Suite 400, Bellevue, WA 98004-4623 | 2008-08-02 |
| 1013177237 | Ashok Shimoji-krishnan | Psychiatry & Neurology | 13451 Se 36th St, Bellevue, WA 98006-1475 | 2008-06-11 |
| 1871648204 | Carola E Bosenberg | Psychiatry & Neurology | 1611 116th Ave Ne, Suite 218, Bellevue, WA 98004-3045 | 2007-01-24 |
| 1053487306 | Edward William Freedman | Psychiatry & Neurology | 1621 114th Ave Se, Suite 221, Bellevue, WA 98004-6956 | 2006-11-28 |
| 1851465959 | Irving J Kohlberg | Psychiatry & Neurology | 1300 114th Ave Se, Suite 115, Bellevue, WA 98004-6942 | 2006-11-20 |
| 1699849703 | John F Pastor | Psychiatry & Neurology | 1300 114th Ave Se, Suite 115, Bellevue, WA 98004-6942 | 2006-11-20 |
| Find all providers in BELLEVUE | ||||
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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.