Active NPI
Daryn Scott Tenenbaum, LCSW
- Clinical Social Worker
- Putnam, CT
National Provider Identifier
1841396249
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 004608
- Practice address
- 107 Providence St
Putnam, CT 06260 - Phone
- (860) 963-2658
- Fax
- (860) 963-2658
- NPI assigned
- Sep 15, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 004608 | CT | Primary |
Addresses
Primary practice location
107 Providence St
Putnam, CT 06260
Mailing address
107 Providence St
PO Box 84
Putnam, CT 06260
Phone (860) 963-2658
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P2543702 | Other | CT | OXFORD |
| 164693 | Other | CT | HEALTHNET |
| 140004608CT01 | Other | CT | ANTHEMBCBS |
| 2686-8 | Other | RI | BCBS OF RI |
| 164693 | Other | CT | TRICARE REGION 1 |
| 412176 | Other | RI | BLUECHIP |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 004608 | CT | MD | Psychiatric/Mental Health Clinical Nurse Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158278400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1841396249",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "107 PROVIDENCE ST",
"address_2": "PO BOX 84",
"city": "PUTNAM",
"state": "CT",
"postal_code": "06260",
"telephone_number": "860-963-2658",
"fax_number": "860-963-2658"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "107 PROVIDENCE ST",
"city": "PUTNAM",
"state": "CT",
"postal_code": "06260",
"telephone_number": "860-963-2658",
"fax_number": "860-963-2658"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TENENBAUM",
"first_name": "DARYN",
"middle_name": "SCOTT",
"name_prefix": "Mr.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CT",
"license": "004608",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OXFORD",
"identifier": "P2543702",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHNET",
"identifier": "164693",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEMBCBS",
"identifier": "140004608CT01",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF RI",
"identifier": "2686-8",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE REGION 1",
"identifier": "164693",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECHIP",
"identifier": "412176",
"state": "RI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Putnam, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.