Individual provider Active NPI

Elena Jean Tenenbaum, PHD

  • Clinical Child & Adolescent Psychologist
  • Durham, NC
National Provider Identifier
1770073041
Registry record updated May 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
License
PENDING Issued in NC
Practice address
2608 Erwin Rd
Durham, NC 27705-4596
Phone
(919) 668-5559
NPI assigned
May 13, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 13, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent Psychologist 103TC2200X PENDING NC Primary

Addresses

Primary practice location

2608 Erwin Rd
Durham, NC 27705-4596

Mailing address

2608 Erwin Rd
Durham, NC 27705-4596

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20191010000449 NC Practitioner - Clinical Psychologist 8921339680 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Duke Health Integrated Practice IncGroup PAC ID 8325412737, 3,140 clinicians

Practice addresses (Care Compare)

2608 Erwin Rd
Durham, NC 27705-4597
Phone (919) 684-8111

40 Duke Medicine Cir
Durham, NC 27710-4000
Phone (919) 684-8111

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PENDINGNCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Duke Health Integrated Practice, Inc. CurrentSince Jul 1, 2023 Accepting new patients

Locations

2100 Erwin Rd
Durham, NC 27705
Phone (919) 648-8111

402 Trent Dr
Durham, NC 27705
Phone (919) 668-5559

2608 Erwin Rd
Ste 300
Durham, NC 27705
Phone (919) 385-3232

3000 Erwin Rd
Durham, NC 27705
Phone (919) 668-3988

40 Duke Medicine Cir
Durham, NC 27710
Phone (919) 681-6588

2301 Erwin Rd
Durham, NC 27705
Phone (919) 668-0289

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1526169600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526169600000",
    "number": "1770073041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2608 ERWIN RD",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277054596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2608 ERWIN RD",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277054596",
            "telephone_number": "919-668-5559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TENENBAUM",
        "first_name": "ELENA",
        "middle_name": "JEAN",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-13",
        "last_updated": "2018-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "NC",
            "license": "PENDING",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Durham, NC

Sources for this page

Verify at the official NPI Registry.