Unknown Individual – Clinical Social Worker, NPI 1063845766

Clinical Social Worker

Unknown Individual is a healthcare provider. based in Cheshire, Connecticut. specializing in Clinical Social Worker. They hold a License No. 10596 (). The NPI Number for Unknown Individual is 1063845766

Main info

Organization

Inactive

15 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1063845766

Phone

(203) 699-6318

Address

1113 S MAIN ST STE F

Deactivation Date

13 November 2025

Doctor Profile

Medical School Name

OTHER

Secondary Phone

2036996318

Graduation Year

2011 (15 years ago)

PAC ID

3678905874

Group Practice PAC ID

0749612935

Professional Enrollment ID

I20191108001228

Data current as of

20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience9

Completeness75

Years active:0State licenses:1Digital endpointsOther names

Provider Addresses for Unknown Individual

1113 S MAIN ST STE F
CHESHIRE, CT 064103436
Phone: (203) 699-6318
Type: Mailing
707 Green Meadow Ln
Smyrna, TN 371675893
Phone: (615) 933-6127
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 06410)

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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: 0749612935View full group profile

Name	Specialty	State
BRITTNEY R JACKSON (MSW, MBA, LCSW)	-	SC

Reviews

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Frequently asked questions

What identifier follows Unknown Individual across health systems?

The NPI 1063845766 uniquely identifies Unknown Individual in U.S. healthcare data.

Should I call the clinic if Unknown Individual is inactive here?

If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.

What does the directory say Unknown Individual does?

Insurance directories may phrase it differently, but here Unknown Individual maps to Clinical Social Worker. Clinical services aligned with this taxonomy classification.

What geographic area is tied to Unknown Individual?

Unknown Individual is associated with Cheshire, Connecticut in the same public data insurers reference.

Can I verify credentials using only NPI?

NPI confirms identity in the directory; licensure and board certification require separate checks.