Individual provider Active NPI

Elaine H. Tulis, PH.D.

  • Clinical Psychologist
  • Chappaqua, NY
National Provider Identifier
1235207580
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
6469-1 Issued in NY
Practice address
21 Gray Rock LN
Chappaqua, NY 10514-2511
Phone
(914) 238-5359
Fax
(914) 238-5359
NPI assigned
Dec 2, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 6469-1 NY Primary

Addresses

Primary practice location

21 Gray Rock LN
Chappaqua, NY 10514-2511

Mailing address

21 Gray Rock LN
Chappaqua, NY 10514-2511
Phone (914) 238-5359

Other identifiers 2

IdentifierTypeStateIssuer
0022639OtherNYGHI
00584414MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120126000020 NY Practitioner - Clinical Psychologist 2961679345 Practice locations: Chappaqua, NY

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

21 Gray Rock Lane
Chappaqua, NY 10514-2511
Phone (914) 238-5359

21 Gray Rock LN
Chappaqua, NY 10514-2511

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
006469NYMDMental Health Counselor
6469-1NYMDClinical Psychologist

NPI Registry JSON

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

{
    "created_epoch": "1165017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1235207580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 GRAY ROCK LN",
            "city": "CHAPPAQUA",
            "state": "NY",
            "postal_code": "105142511",
            "telephone_number": "914-238-5359",
            "fax_number": "914-238-5359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 GRAY ROCK LN",
            "city": "CHAPPAQUA",
            "state": "NY",
            "postal_code": "105142511",
            "telephone_number": "914-238-5359",
            "fax_number": "914-238-5359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TULIS",
        "first_name": "ELAINE",
        "middle_name": "H.",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-02",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "6469-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "0022639",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00584414",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chappaqua, NY

Sources for this page

Verify at the official NPI Registry.