Unknown Individual – Clinical Social Worker, NPI 1497764575

Clinical Social Worker

Unknown Individual is a healthcare provider. based in Enfield, Connecticut. specializing in Clinical Social Worker. They hold a License No. 002418 (CT). The NPI Number for Unknown Individual is 1497764575

Main info

Organization

Inactive

47 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1497764575

Phone

(860) 749-1111

Address

139 HAZARD AVE

Deactivation Date

9 October 2025

Doctor Profile

Medical School Name

STATE UNIVERSITY OF NEW YORK AT BUFFALO SCHOOL OF MEDICINE

Secondary Phone

8607491111

Graduation Year

1979 (47 years ago)

PAC ID

9830356799

Professional Enrollment ID

I20120203000358

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience14

Completeness75

Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

139, Hazard Avenue, Hazardville, Enfield, Hartford County, Connecticut, 06082, United States
BLDG.2 SUITE 7
ENFIELD, CT 060824585
Phone: (860) 749-1111
Fax: (413) 567-2498
Mailing address matches the actual address.

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 06082)

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Reviews

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Frequently asked questions

Is Unknown Individual listed with a National Provider Identifier?

Yes — Unknown Individual has NPI 1497764575 on file in the registry.

Is inactive the same as retired for Unknown Individual?

Inactive registry status can reflect deactivation, consolidation, or data lag.

How would a patient describe Unknown Individual's focus?

For Unknown Individual, the primary taxonomy reads as Clinical Social Worker. Clinical services aligned with this taxonomy classification.

Where in Connecticut is Unknown Individual registered?

Use Enfield, Connecticut as the headline location for Unknown Individual here.

Does inactive status remove historical data?

Historical rows can remain visible after status changes — read the dates carefully.

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