Unknown Individual – Clinical Social Worker, NPI 1194029637

Unknown Individual is a healthcare provider. based in Long beach, California. specializing in Clinical Social Worker. They hold a License No. CSW005901 (GA). The NPI Number for Unknown Individual is 1194029637

Main info

Organization
Inactive
15 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1194029637
Phone
(562) 896-0970
Address
PO BOX 15933
Deactivation Date
15 May 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7703585252
Graduation Year
2011 (15 years ago)
PAC ID
9638440217
Group Practice PAC ID
6204818669
Professional Enrollment ID
I20170731002450

Contacts

Other Endpoint
tfis626@gmail.com
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience19
Completeness85
Years active:0State licenses:1Other namesUpdated within 12 months

Provider Addresses for Unknown Individual

  • PO BOX 15933

    LONG BEACH, CA 908150933

    Phone: (562) 896-0970

    Type: Mailing

  • 340 HOSPITAL DR

    MACON, GA 312173838

    Phone: (478) 741-1355

    Type: Location

  • 340 Hospital Dr

    Macon, GA 312173838

    Phone: (478) 741-1355

    Type: Location

  • 1602 Carriage Hills Dr

    Griffin, GA 302248826

    Phone: (470) 295-5017

    Fax: (470) 204-7604

    Type: Location

  • 1602 CARRIAGE HILLS DR

    GRIFFIN, GA 302248826

    Phone: (470) 295-5017

    Fax: (470) 204-7604

    Type: Mailing

  • 410 E TAYLOR ST STE L2

    GRIFFIN, GA 302233424

    Phone: (770) 897-4002

    Fax: (470) 204-7604

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 90815)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 6204818669View full group profile
NameSpecialtyState
Mental Health CounselorGA
Mental Health CounselorGA
Nurse PractitionerGA
Nurse PractitionerGA
Psychiatry, Addiction MedicineGA
-GA
-GA
Nurse PractitionerGA
P S Y C H I A T R YGA
Nurse PractitionerGA

Reviews

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Frequently asked questions

How is Unknown Individual identified in CMS data?
CMS-hosted NPPES data lists Unknown Individual with NPI 1194029637.
Is Unknown Individual's NPI deactivated?
The extract indicates Unknown Individual is not in an active NPI state.
What healthcare role does Unknown Individual hold?
Scheduling teams often label Unknown Individual under Clinical Social Worker. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual based?
Unknown Individual is tied to Long Beach, California in the data we show; additional addresses may exist on the full record.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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