Unknown Individual – Addiction (Substance Use Disorder) Counselor, NPI 1194879387

Unknown Individual is a healthcare provider. based in Brockton, Massachusetts. specializing in Addiction (Substance Use Disorder) Counselor. They hold a License No. 1023734 (MA). The NPI Number for Unknown Individual is 1194879387

Main info

Organization
Inactive
34 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1194879387
Phone
(508) 742-4420
Address
30 MEADOWBROOK RD.
Deactivation Date
14 August 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
-
Graduation Year
1992 (34 years ago)
PAC ID
9931125507
Professional Enrollment ID
I20051022000088
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience19
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 30, Meadowbrook Road, Campello, Brockton, Plymouth County, Massachusetts, 02301, United States

    BROCKTON, MA 02301

    Phone: (508) 742-4420

    Fax: (508) 742-4430

    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.

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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 02301)

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Reviews

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Frequently asked questions

How do I look up Unknown Individual by NPI?
Use NPI 1194879387 when you need to reference Unknown Individual in forms, claims, or directories.
Is Unknown Individual's inactive status permanent?
An inactive NPI does not by itself prove someone stopped practicing — check other sources.
Does Unknown Individual list a primary specialty?
If you are matching referrals, note Addiction (Substance Use Disorder) Counselor for Unknown Individual. Clinical services aligned with this taxonomy classification.
What location metadata exists for Unknown Individual?
The page summarizes Brockton, Massachusetts for Unknown Individual; expand the address list for detail.
Is this NPI for an individual or an organization?
This listing corresponds to an Individual Provider.

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