Unknown Individual – Clinical Psychologist, NPI 1013003011

Unknown Individual is a healthcare provider. based in Cambridge, Massachusetts. specializing in Clinical Psychologist. They hold a License No. 4173 (MA). The NPI Number for Unknown Individual is 1013003011

Main info

Organization
Inactive
45 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1013003011
Phone
(617) 491-1269
Address
675 MASSACHUSETTS AVE
Deactivation Date
7 August 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
6174911269
Graduation Year
1981 (45 years ago)
PAC ID
7113191800
Group Practice PAC ID
7416919048
Professional Enrollment ID
I20111115000218
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

  • Leader Bank, 675, Massachusetts Avenue, Central Square, Cambridge, Middlesex County, Massachusetts, 02139, United States

    CAMBRIDGE, MA 021393309

    Phone: (617) 491-1269

    Fax: (617) 864-8586

    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 02139)

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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: 7416919048View full group profile

Reviews

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Frequently asked questions

What unique ID ties claims to Unknown Individual?
NPI 1013003011 is assigned to Unknown Individual under the national enumeration system.
Is Unknown Individual's inactive status permanent?
An inactive NPI does not by itself prove someone stopped practicing — check other sources.
What field does Unknown Individual work in?
You can think of Unknown Individual as practicing within Clinical Psychologist. Clinical services aligned with this taxonomy classification.
Where does public data place Unknown Individual?
The snapshot lists Cambridge, Massachusetts for Unknown Individual; download NPPES for the complete set.
How can I contact Unknown Individual?
Phone or fax may appear on the official NPI record when supplied — verify before relying on them.

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