Unknown Individual – Clinical Social Worker, NPI 1003825480

Unknown Individual is a healthcare provider. based in Waban, Massachusetts. specializing in Clinical Social Worker. They hold a License No. 104180 (MA). The NPI Number for Unknown Individual is 1003825480

Main info

Organization
Inactive
47 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1003825480
Phone
(617) 244-1418
Address
575 CHESTNUT ST
Deactivation Date
27 September 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
6178552183
Graduation Year
1979 (47 years ago)
PAC ID
4688860158
Group Practice PAC ID
9436040961
Professional Enrollment ID
I20101123000382
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

  • 575, Chestnut Street, Waban, West Newton, Newton, Middlesex County, Massachusetts, 02468, United States

    WABAN, MA 024681225

    Phone: (617) 244-1418

    Type: Mailing

  • 150 S Huntington Ave, South Huntington Avenue, Jamaica Plain, Boston, Suffolk County, Massachusetts, 02130-4803, United States

    PSYCHIATRY 116A

    BOSTON, MA 021304817

    Phone: (617) 232-9500

    Fax: (857) 364-4445

    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 02468)

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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: 9436040961View full group profile
NameSpecialtyState
Clinical Social WorkerMA
Clinical PsychologistMA
Clinical PsychologistMA
Clinical Social WorkerMA
-MA
Psychiatry, Geriatric PsychiatryMA
Clinical PsychologistMA
Clinical PsychologistMA
Clinical PsychologistRI
-MA

Reviews

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Frequently asked questions

Does Unknown Individual have a public NPI I can cite?
Public records show Unknown Individual under NPI 1003825480.
Does inactive mean outdated data for Unknown Individual?
Inactive status means the NPI record is not marked active in the public file — verify before making care decisions.
What type of care does Unknown Individual provide?
Unknown Individual's profile centers on Clinical Social Worker. Clinical services aligned with this taxonomy classification.
Which community is linked to Unknown Individual?
Unknown Individual shows a connection to Waban, Massachusetts in registry-derived data.
Why is information missing for Unknown Individual?
Providers choose how much contact data to publish. Missing fields do not mean the profile is fake.

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