Unknown Individual – Clinical Psychologist, NPI 1083653216

Unknown Individual is a healthcare provider. based in Belmont, Massachusetts. specializing in Clinical Psychologist. They hold a License No. 508 (MA). The NPI Number for Unknown Individual is 1083653216

Main info

Organization
Inactive
54 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1083653216
Phone
(617) 855-3209
Address
115 MILL ST
Deactivation Date
28 August 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
6178553168
Graduation Year
1972 (54 years ago)
PAC ID
3971530486
Professional Enrollment ID
I20050726000592
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

  • McLean Hospital, 115, Mill Street, Kendall Gardens, Belmont, Middlesex County, Massachusetts, 02478, United States

    BELMONT, MA 024781041

    Phone: (617) 855-3209

    Fax: (617) 855-3776

    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.

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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 02478)

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Reviews

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Frequently asked questions

Does Unknown Individual share an NPI with anyone else?
NPI numbers are unique to each provider or organization — Unknown Individual uses 1083653216.
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 taxonomy line describes Unknown Individual?
For research purposes, treat Unknown Individual as Clinical Psychologist in this dataset. Clinical services aligned with this taxonomy classification.
What area does Unknown Individual serve?
Unknown Individual's listing highlights Belmont, Massachusetts; more addresses can appear in NPPES.
Why does Unknown Individual have multiple addresses?
2 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

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