Unknown Individual – Psychologist, NPI 1710020193

Unknown Individual is a healthcare provider. based in Madison, Connecticut. specializing in Psychologist. They hold a License No. 0000764 (CT). The NPI Number for Unknown Individual is 1710020193

Main info

Organization
Inactive
47 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1710020193
Phone
(203) 318-8399
Address
147 DURHAM RD
Deactivation Date
21 April 2021

Doctor Profile

Medical School Name
OTHER
Secondary Phone
2033188399
Graduation Year
1979 (47 years ago)
PAC ID
4082898432
Professional Enrollment ID
I20110408000026
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

Provider Addresses for Unknown Individual

  • 147 DURHAM RD

    MADISON, CT 064432675

    Phone: (203) 318-8399

    Fax: (203) 453-8724

    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.

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Medicare Enrollment & Revalidation

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

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

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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 06443)

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Reviews

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Frequently asked questions

How do I look up Unknown Individual by NPI?
Use NPI 1710020193 when you need to reference Unknown Individual in forms, claims, or directories.
Is Unknown Individual's inactive status permanent?
An inactive NPI does not by itself prove someone stopped practicing — check other sources.
Does Unknown Individual list a primary specialty?
If you are matching referrals, note Psychologist for Unknown Individual. Clinical services aligned with this taxonomy classification.
What location metadata exists for Unknown Individual?
The page summarizes Madison, Connecticut for Unknown Individual; expand the address list for detail.
Does Medicare enrollment show here?
Medicare enrollment screens are separate from the basic NPI extract shown here.

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