Unknown Individual – Clinical Social Worker, NPI 1609172261

Unknown Individual is a healthcare provider. based in River forest, Illinois. specializing in Clinical Social Worker. They hold a License No. 149.008983 (IL). The NPI Number for Unknown Individual is 1609172261

Main info

Organization
Inactive
30 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1609172261
Phone
(708) 366-7090
Address
1530 JACKSON AVE
Deactivation Date
27 March 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
6302611210
Graduation Year
1996 (30 years ago)
PAC ID
6103003785
Group Practice PAC ID
0042374720
Professional Enrollment ID
I20110608000112
Data current as of
20 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

  • 1530 JACKSON AVE

    RIVER FOREST, IL 603051190

    Phone: (708) 366-7090

    Fax: (708) 366-7092

    Type: Mailing

  • 2340 S HIGHLAND AVE

    LOMBARD, IL 601485371

    Phone: (630) 261-1210

    Fax: (630) 261-1211

    Type: Location

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 60305)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 0042374720View full group profile
NameSpecialtyState
P S Y C H I A T R YIL
P S Y C H I A T R YIL
Clinical Social WorkerIL
P S Y C H I A T R YIL
Clinical Social WorkerIL
Clinical Social WorkerIL
Nurse PractitionerIL
Mental Health CounselorIL
Clinical Social WorkerIL
Mental Health CounselorIL

Reviews

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Frequently asked questions

How is Unknown Individual identified in CMS data?
CMS-hosted NPPES data lists Unknown Individual with NPI 1609172261.
What dates should I check for Unknown Individual's activity?
We display what the registry publishes: Unknown Individual appears inactive there.
What is Unknown Individual's specialty?
The listing groups Unknown Individual with Clinical Social Worker. Clinical services aligned with this taxonomy classification.
Where should I expect Unknown Individual on a map?
Expect River Forest, Illinois as a primary anchor for Unknown Individual unless the record lists multiple sites.
How many locations tie to this NPI?
2 practice locations appear in the available data.

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