Unknown Individual – Clinical Psychologist, NPI 1114047891

Unknown Individual is a healthcare provider. based in Deland, Florida. specializing in Clinical Psychologist. They hold a License No. PY 9741 (FL). The NPI Number for Unknown Individual is 1114047891

Main info

Organization
Inactive
13 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1114047891
Phone
(386) 943-9040
Address
1109 W EUCLID AVE
Deactivation Date
25 December 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3869439040
Graduation Year
2013 (13 years ago)
PAC ID
8022386267
Professional Enrollment ID
I20170613000627
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

  • 1109 W EUCLID AVE

    DELAND, FL 327206553

    Phone: (386) 943-9040

    Fax: (386) 943-9937

    Type: Mailing

  • 627 N GRANDVIEW AVE STE 242

    DAYTONA BEACH, FL 321183806

    Phone: (570) 404-4740

    Fax: (855) 856-5818

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

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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.

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Medicare Utilization (FFS)

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

Insurance plans in this area (ZIP 32720)

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Reviews

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Frequently asked questions

What number should I use to identify Unknown Individual for billing?
Administrative and clinical systems typically use NPI 1114047891 for Unknown Individual.
What should I verify if Unknown Individual is listed inactive?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
What services align with Unknown Individual's listing?
Unknown Individual's public classification highlights Clinical Psychologist. Clinical services aligned with this taxonomy classification.
What city is tied to Unknown Individual?
The directory associates Unknown Individual with Deland, Florida. Check all listed addresses for suites or satellite offices.
Who maintains Unknown Individual's record?
Providers certify NPPES data; CMS hosts the public file you are viewing.

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