Unknown Individual – Clinical Social Worker, NPI 1205816634

Unknown Individual is a healthcare provider. based in Boston, Massachusetts. specializing in Clinical Social Worker. They hold a License No. 1022832 (MA). The NPI Number for Unknown Individual is 1205816634

Main info

Organization
Inactive
36 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1205816634
Phone
(800) 885-2225
Address
PO BOX 415348
Deactivation Date
28 November 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
5087532060
Graduation Year
1990 (36 years ago)
PAC ID
5496831752
Group Practice PAC ID
4284539891
Professional Enrollment ID
I20080326000858

Contacts

Secure Messaging
mbennett22208@UmassMemorial.direct-ci.com
FHIR Endpoint
https://epicproxy.et0978.epichosted.com/FHIRProxy/api/FHIR/DSTU2/
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness85
Years active:0State licenses:1Other namesUpdated within 12 months

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Provider Addresses for Unknown Individual

  • PO Box 846028, Albany Street, Church Green, Financial District, Boston, Suffolk County, Massachusetts, 02284-6028, United States

    BOSTON, MA 022415348

    Phone: (800) 885-2225

    Fax: (508) 334-1977

    Type: Mailing

  • Hospital for Behavioral Medicine, 100, Century Drive, Worcester, Worcester County, Massachusetts, 01653, United States

    WORCESTER, MA 016061244

    Phone: (508) 762-5400

    Fax: (508) 762-5410

    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 02241)

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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: 4284539891View full group profile
NameSpecialtyState
Certified Registered Nurse Anesthetist (Crna)MA
-MA
-MA
Family PracticeMA
Physician AssistantMA
Pulmonary Disease, Critical Care (Intensivists), Allergy/ImmunologyMA
-MA
-MA
Internal MedicineMA
Nurse PractitionerMA

Reviews

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Frequently asked questions

What is the 10-digit NPI for Unknown Individual?
Unknown Individual — NPI 1205816634 — is the standard way to identify this listing.
Why might Unknown Individual appear inactive while still practicing?
We display what the registry publishes: Unknown Individual appears inactive there.
What is Unknown Individual's primary classification?
Clinical Social Worker is the headline specialty for Unknown Individual here. Clinical services aligned with this taxonomy classification.
Does Unknown Individual list a practice location?
Patients near Boston, Massachusetts may find Unknown Individual in results; validate coverage separately.
How many locations tie to this NPI?
2 practice locations appear in the available data.

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