Unknown Individual – Clinical Social Worker, NPI 1114083326

Unknown Individual is a healthcare provider. based in Fort mitchell, Kentucky. specializing in Clinical Social Worker. They hold a License No. KY-2004 (KY). The NPI Number for Unknown Individual is 1114083326

Main info

Organization
Inactive
24 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1114083326
Phone
(859) 380-2987
Address
2234 DOMINION DR
Deactivation Date
26 December 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
8592820119
Graduation Year
2002 (24 years ago)
PAC ID
5890983225
Group Practice PAC ID
4981976222
Professional Enrollment ID
I20101229000119
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

  • 2234, Dominion Drive, Fort Mitchell, Kenton County, Kentucky, 41017, United States

    FORT MITCHELL, KY 410172017

    Phone: (859) 380-2987

    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.

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 41017)

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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: 4981976222View full group profile
NameSpecialtyState
Clinical PsychologistKY
Clinical PsychologistKY
Clinical Social WorkerKY
-KY
Mental Health CounselorKY
Mental Health CounselorKY
Clinical Social WorkerKY
-KY
Clinical Social WorkerKY

Reviews

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Frequently asked questions

How do payers reference Unknown Individual?
For Unknown Individual, use NPI 1114083326 as the unique 10-digit identifier.
Is Unknown Individual still active if the NPI shows inactive?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
What clinical focus is listed for Unknown Individual?
At a glance, Unknown Individual is tied to Clinical Social Worker. Clinical services aligned with this taxonomy classification.
What locale is associated with Unknown Individual?
Directory geography for Unknown Individual centers on Fort Mitchell, Kentucky.
Does Unknown Individual accept insurance?
Insurance participation is not part of the core NPI extract — call the plan or office to confirm.

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