Unknown Individual – Social Worker, NPI 1376814350

Unknown Individual is a healthcare provider. based in Brockton, Massachusetts. specializing in CLINICAL SOCIAL WORKER. The NPI Number for Unknown Individual is 1376814350

Main info

Organization
Inactive
4 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1376814350
Phone
(508) 309-2942
Address
10 MEADOWBROOK RD
Deactivation Date
16 April 2026

Doctor Profile

Medical School Name
BOSTON UNIVERSITY SCHOOL OF MEDICINE
Secondary Phone
5082220089
Graduation Year
2022 (4 years ago)
PAC ID
9032575030
Group Practice PAC ID
7911213764
Professional Enrollment ID
I20230526001073
Address ID
MA027032338AT24XXXSTXX300
Telehealth
Yes
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience10
Completeness75
Years active:0State licenses:0Digital endpointsOther names

4,194 CLINICAL SOCIAL WORKER in MA

Provider Addresses for Unknown Individual

  • 10 MEADOWBROOK RD

    BROCKTON, MA 023017122

    Phone: (508) 309-2942

    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.

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20230526001073IClinical Social WorkerMATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

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 02301)

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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: 7911213764View full group profile
NameSpecialtyState
Clinical Social WorkerMA
Psychiatry, Addiction Medicine, Geriatric PsychiatryMA
Nurse PractitionerMA
-MA
Nurse PractitionerMA
Nurse PractitionerMA
Nurse PractitionerMA

Reviews

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Frequently asked questions

What unique ID ties claims to Unknown Individual?
NPI 1376814350 is assigned to Unknown Individual under the national enumeration system.
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 Social Worker for Unknown Individual. Clinical services aligned with this taxonomy classification.
What location shows for Unknown Individual?
We surface Brockton, Massachusetts for Unknown Individual based on available NPPES addresses.
How can I contact Unknown Individual?
Phone or fax may appear on the official NPI record when supplied — verify before relying on them.

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