Unknown Individual – Clinical Psychologist, NPI 1679663892

Unknown Individual is a healthcare provider. based in Weymouth, Massachusetts. specializing in Clinical Psychologist. They hold a License No. 1809 (MA). The NPI Number for Unknown Individual is 1679663892

Main info

Organization
Inactive
34 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1679663892
Phone
(781) 682-1060
Address
169 LIBBEY INDUSTRIAL PKWY
Deactivation Date
5 April 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
6174794545
Graduation Year
1992 (34 years ago)
PAC ID
4486654084
Group Practice PAC ID
4183524887
Professional Enrollment ID
I20070104000424
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

  • 169, Libbey Industrial Parkway, Weymouth, Norfolk County, Massachusetts, 02189, United States

    2ND FLOOR

    WEYMOUTH, MA 021893101

    Phone: (781) 682-1060

    Fax: (781) 682-1061

    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.

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 02189)

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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: 4183524887View full group profile
NameSpecialtyState
Nurse PractitionerMA
Clinical PsychologistMA
-MA
Clinical Social WorkerMA
Clinical Social WorkerMA
-MA
-MA
Clinical PsychologistVA
-MA
Clinical Social WorkerMA

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Frequently asked questions

Where can patients find Unknown Individual's NPI?
You can confirm Unknown Individual with NPI 1679663892; it appears in the national provider directory.
Why would Unknown Individual's listing show inactive?
Inactive in NPPES means the identifier is not currently active in that dataset.
What kind of provider is Unknown Individual?
The page reflects Clinical Psychologist for Unknown Individual. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual's primary listing?
We display Weymouth, Massachusetts because that is what the record indicates for Unknown Individual.
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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