Unknown Individual – Clinical Psychologist, NPI 1710001151

Unknown Individual is a healthcare provider. based in Cambridge, Massachusetts. specializing in Clinical Psychologist. They hold a License No. 4694 (MA). The NPI Number for Unknown Individual is 1710001151

Main info

Organization
Inactive
38 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1710001151
Phone
(617) 547-0345
Address
127 MOUNT AUBURN STREET
Deactivation Date
20 March 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
6175470345
Graduation Year
1988 (38 years ago)
PAC ID
6406023548
Professional Enrollment ID
I20120525000129
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

Provider Addresses for Unknown Individual

  • 127 MOUNT AUBURN STREET

    CAMBRIDGE, MA 02138

    Phone: (617) 547-0345

    Fax: (781) 259-8198

    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 02138)

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Reviews

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Frequently asked questions

What is the registry number for Unknown Individual?
The registry entry for Unknown Individual shows NPI 1710001151.
Does inactive mean outdated data for Unknown Individual?
Inactive status means the NPI record is not marked active in the public file — verify before making care decisions.
Which specialty label fits Unknown Individual?
NPPES ties Unknown Individual to Clinical Psychologist in the taxonomy section. Clinical services aligned with this taxonomy classification.
What geographic area is tied to Unknown Individual?
Unknown Individual is associated with Cambridge, Massachusetts in the same public data insurers reference.
Can I export Unknown Individual's record?
You can download the official NPPES record; we summarize key fields for readability.