Unknown Individual – Clinical Psychologist, NPI 1205905130

Unknown Individual is a healthcare provider. based in Medford, Massachusetts. specializing in Clinical Psychologist. They hold a License No. 3974 (MA). The NPI Number for Unknown Individual is 1205905130

Main info

Organization
Inactive
41 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1205905130
Phone
(781) 391-8899
Address
92 HIGH ST
Deactivation Date
18 June 2021

Doctor Profile

Medical School Name
BOSTON UNIVERSITY SCHOOL OF MEDICINE
Secondary Phone
7813918899
Graduation Year
1985 (41 years ago)
PAC ID
8921098997
Professional Enrollment ID
I20040513000510
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

  • 92, High Street, Medford, Middlesex County, Massachusetts, 02155, United States

    DH31

    MEDFORD, MA 021553850

    Phone: (781) 391-8899

    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 02155)

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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 1205905130 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.
What area does Unknown Individual serve?
Unknown Individual's listing highlights Medford, Massachusetts; more addresses can appear in NPPES.
How many locations tie to this NPI?
2 practice locations appear in the available data.

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