Unknown Individual – Clinical Psychologist, NPI 1649441148

Unknown Individual is a healthcare provider. based in Darien, Illinois. specializing in Clinical Psychologist. They hold a License No. 071-004031 (IL). The NPI Number for Unknown Individual is 1649441148

Main info

Organization
Inactive
38 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1649441148
Phone
(630) 654-8146
Address
712 ANDERMANN LN
Deactivation Date
21 June 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
2197361000
Graduation Year
1988 (38 years ago)
PAC ID
1759468010
Group Practice PAC ID
7416082086
Professional Enrollment ID
I20170412001536
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

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Provider Addresses for Unknown Individual

  • 712, Andermann Lane, Lace, Darien, DuPage County, Illinois, 60561, United States

    #109

    DARIEN, IL 605614854

    Phone: (630) 654-8146

    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

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)

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

Insurance plans in this area (ZIP 60561)

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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: 7416082086View full group profile
NameSpecialtyState
Clinical PsychologistIN
Clinical Social WorkerIN
Mental Health CounselorIN
Clinical PsychologistIL
Clinical PsychologistIN
Clinical PsychologistIN

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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 1649441148 for Unknown Individual.
Should I call the clinic if Unknown Individual is inactive here?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
What type of care does Unknown Individual provide?
Unknown Individual's profile centers on Clinical Psychologist. Clinical services aligned with this taxonomy classification.
Is Unknown Individual tied to Darien, Illinois?
If you are local to Darien, Illinois, Unknown Individual may be relevant to your search.
Can I verify credentials using only NPI?
NPI confirms identity in the directory; licensure and board certification require separate checks.

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