Unknown Individual – Psychiatric/Mental Health Nurse Practitioner, NPI 1710906417

Unknown Individual is a healthcare provider. based in Andover, Massachusetts. specializing in Psychiatric/Mental Health Nurse Practitioner. They hold a License No. 164508 (MA). The NPI Number for Unknown Individual is 1710906417

Main info

Organization
Inactive
34 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1710906417
Phone
(978) 470-0520
Address
1 Elm Sq
Deactivation Date
5 July 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9788861423
Graduation Year
1992 (34 years ago)
PAC ID
0345286175
Professional Enrollment ID
I20050701000705
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

Provider Addresses for Unknown Individual

  • 1 Elm Sq

    Andover, MA 018103643

    Phone: (978) 470-0520

    Fax: (978) 475-1181

    Type: Location

  • 213, Washington Street, South Groveland, Groveland, Essex County, Massachusetts, 01834, United States

    GROVELAND, MA 018341008

    Phone: (978) 886-1423

    Fax: (978) 373-3845

    Type: Mailing

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 01810)

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Provider's Procedures

Unknown Individual performs procedures in Psychiatric/Mental Health Nurse Practitioner. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
CERTIFIED CLINICAL NURSE SPECIALISTMA90836Psychotherapy, 45 minutes with patient and/or family member3911

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Frequently asked questions

What federal number belongs to Unknown Individual?
The federal identifier for Unknown Individual is NPI 1710906417.
How do I interpret inactive records for Unknown Individual?
Treat inactive as a signal to verify Unknown Individual through official channels.
What does Unknown Individual treat or focus on?
Patients typically see Unknown Individual under the specialty Psychiatric/Mental Health Nurse Practitioner. Clinical services aligned with this taxonomy classification.
Where does public data place Unknown Individual?
The snapshot lists Andover, Massachusetts for Unknown Individual; download NPPES for the complete set.
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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