Unknown Individual – Clinical Social Worker, NPI 1114931334

Unknown Individual is a healthcare provider. based in Waterville, Maine. specializing in Clinical Social Worker. They hold a License No. LC11237 (ME). The NPI Number for Unknown Individual is 1114931334

Main info

Organization
Inactive
25 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1114931334
Phone
(207) 873-2136
Address
67 EUSTIS PKWY
Deactivation Date
11 December 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
2078721000
Graduation Year
2001 (25 years ago)
PAC ID
5395828610
Group Practice PAC ID
1254245715
Professional Enrollment ID
I20080211000189
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

  • 67, Eustis Parkway, Waterville, Kennebec County, Maine, 04901, United States

    WATERVILLE, ME 049015173

    Phone: (207) 873-2136

    Fax: (207) 872-4522

    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 04901)

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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: 1254245715View full group profile

Reviews

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Frequently asked questions

What federal number belongs to Unknown Individual?
The federal identifier for Unknown Individual is NPI 1114931334.
Why would Unknown Individual's listing show inactive?
Inactive in NPPES means the identifier is not currently active in that dataset.
What does Unknown Individual treat or focus on?
Patients typically see Unknown Individual under the specialty Clinical Social Worker. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual's primary listing?
We display Waterville, Maine because that is what the record indicates for Unknown Individual.
Is this NPI for an individual or an organization?
This listing corresponds to an Individual Provider.

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