Active NPI
Peter David Tenenbaum, MSW, LICSW
- Social Worker
- White River Junction, VT
National Provider Identifier
1104254515
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 089.0000242
- Practice address
- 67 Raymond Circle
White River Junction, VT 05001 - Phone
- (802) 291-1789
- NPI assigned
- Oct 22, 2013
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 089.0000242 | VT | Primary |
| Social Worker | 104100000X | 1112 | NH |
Addresses
Primary practice location
67 Raymond Circle
White River Junction, VT 05001
Mailing address
67 Raymond Circle
White River Junction, VT 05001
Phone (802) 291-1789
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 |
|---|---|---|---|
| 089.0000242 | VT | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1382400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1382400000000",
"number": "1104254515",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "67 RAYMOND CIRCLE",
"city": "WHITE RIVER JUNCTION",
"state": "VT",
"postal_code": "05001",
"telephone_number": "802-291-1789"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "67 RAYMOND CIRCLE",
"city": "WHITE RIVER JUNCTION",
"state": "VT",
"postal_code": "05001",
"telephone_number": "802-291-1789"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TENENBAUM",
"first_name": "PETER",
"middle_name": "DAVID",
"name_prefix": "Mr.",
"credential": "MSW, LICSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-10-22",
"last_updated": "2013-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "VT",
"license": "089.0000242",
"primary": true
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NH",
"license": "1112",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in White River Junction, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.