Unknown Individual – Psychiatry Physician, NPI 1568416972

Unknown Individual is a healthcare provider. based in Wethersfield, Connecticut. specializing in Psychiatry Physician. They hold a License No. 20514 (CT). The NPI Number for Unknown Individual is 1568416972

Main info

Organization
Inactive
57 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1568416972
Phone
(860) 721-7911
Address
530 SILAS DEANE HWY
Deactivation Date
16 September 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
-
Graduation Year
1969 (57 years ago)
PAC ID
0941213870
Professional Enrollment ID
I20060719000230
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

  • 530, Silas Deane Highway, Wethersfield, Capitol Planning Region, Connecticut, 06109, United States

    SUITE NUMBER 340

    WETHERSFIELD, CT 061092234

    Phone: (860) 721-7911

    Fax: (860) 257-0272

    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 06109)

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Reviews

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Frequently asked questions

What is the 10-digit NPI for Unknown Individual?
Unknown Individual — NPI 1568416972 — is the standard way to identify this listing.
Why is Unknown Individual marked inactive in the NPI directory?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What taxonomy line describes Unknown Individual?
For research purposes, treat Unknown Individual as Psychiatry Physician in this dataset. Clinical services aligned with this taxonomy classification.
What address line appears for Unknown Individual?
Unknown Individual's geographic hint is Wethersfield, Connecticut in our summary view.
Is specialty guaranteed by NPI alone?
Taxonomy selections describe intent; scope of practice still follows state law.

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