Active NPI
Elisabeth Ruth McKenna, PH.D.
- Psychologist
- Santa Clara, CA
National Provider Identifier
1518012962
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY 16746
- Practice address
- 2100 Walsh Ave
Suite C1
Santa Clara, CA 95050-2545 - Phone
- (408) 497-9977
- NPI assigned
- Jan 24, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY 16746 | CA | Primary |
Addresses
Primary practice location
2100 Walsh Ave
Suite C1
Santa Clara, CA 95050-2545
Mailing address
PO Box 152
Los Altos, CA 94023-0152
Phone (408) 497-9977
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)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY 16746 | CA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169596800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1375920000000",
"number": "1518012962",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 152",
"city": "LOS ALTOS",
"state": "CA",
"postal_code": "940230152",
"telephone_number": "408-497-9977"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2100 WALSH AVE",
"address_2": "SUITE C1",
"city": "SANTA CLARA",
"state": "CA",
"postal_code": "950502545",
"telephone_number": "408-497-9977"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCKENNA",
"first_name": "ELISABETH",
"middle_name": "RUTH",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-24",
"last_updated": "2013-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY 16746",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Clara, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 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.