Unknown Individual – Clinical Psychologist, NPI 1770502858

Unknown Individual is a healthcare provider. based in Homestead, Florida. specializing in Clinical Psychologist. They hold a License No. PY4463 (FL). The NPI Number for Unknown Individual is 1770502858

Main info

Organization
Inactive
36 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1770502858
Phone
(305) 666-7055
Address
100 NE 15TH ST
Deactivation Date
5 March 2026

Doctor Profile

Medical School Name
UNIVERSITY OF MISSOURI, COLUMBIA SCHOOL OF MEDICINE
Secondary Phone
3052453900
Graduation Year
1990 (36 years ago)
PAC ID
9537355276
Professional Enrollment ID
I20101122000015
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

  • 100, Northeast 15th Street, Homestead, Miami-Dade County, Florida, 33030, United States

    #208

    HOMESTEAD, FL 33030

    Phone: (305) 666-7055

    Fax: (305) 245-3901

    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.

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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 33030)

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Reviews

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Frequently asked questions

Is there an official ID for Unknown Individual in U.S. healthcare records?
The official identifier for Unknown Individual is NPI 1770502858.
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 Psychologist. Clinical services aligned with this taxonomy classification.
Where in Florida is Unknown Individual registered?
Use Homestead, Florida as the headline location for Unknown Individual here.
When was this NPI issued?
Enumeration for Unknown Individual is noted as not shown in this record where the registry provides it.

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