Unknown Individual – Clinical Psychologist, NPI 1013097468

Unknown Individual is a healthcare provider. based in Newton, Massachusetts. specializing in Clinical Psychologist. They hold a License No. 6642 (MA). The NPI Number for Unknown Individual is 1013097468

Main info

Organization
Inactive
33 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1013097468
Phone
(617) 965-6388
Address
53 LANGLEY RD
Deactivation Date
18 June 2021

Doctor Profile

Medical School Name
OTHER
Secondary Phone
6178721066
Graduation Year
1993 (33 years ago)
PAC ID
5092713719
Professional Enrollment ID
I20061113000359
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

  • 53, Langley Road, Newton Centre, Newton, Middlesex County, Massachusetts, 02459, United States

    SUITE 370

    NEWTON, MA 024592241

    Phone: (617) 965-6388

    Type: Location

  • 14, Lowell Avenue, Nonantum, Newtonville, Newton, Middlesex County, Massachusetts, 02460, United States

    1

    NEWTONVILLE, MA 024601612

    Phone: (617) 527-1584

    Fax: (617) 527-2002

    Type: Mailing

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

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No Medicare enrollment or revalidation data available for this provider in our database.

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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 02459)

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Reviews

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Frequently asked questions

Can I verify Unknown Individual with an NPI only?
You can start verification with NPI 1013097468 for Unknown Individual, then check state licensing separately.
Is Unknown Individual excluded from programs when inactive?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What is Unknown Individual's primary classification?
Clinical Psychologist is the headline specialty for Unknown Individual here. Clinical services aligned with this taxonomy classification.
Does Unknown Individual list a practice location?
Patients near Newton, Massachusetts may find Unknown Individual in results; validate coverage separately.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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