Unknown Individual – Clinical Social Worker, NPI 1629339858

Unknown Individual is a healthcare provider. based in Detroit, Michigan. specializing in Clinical Social Worker. They hold a License No. 6801093115 (MI). The NPI Number for Unknown Individual is 1629339858

Main info

Organization
Inactive
15 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1629339858
Phone
Not provided
Address
17421 TELEGRAPH RD
Deactivation Date
9 September 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3133591977
Graduation Year
2011 (15 years ago)
PAC ID
6709134034
Group Practice PAC ID
0042289274
Professional Enrollment ID
I20180802003337
Data current as of
20 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

  • 17421 TELEGRAPH RD

    DETROIT, MI 482193165

    Phone:

    Type: Mailing

  • 17321 TELEGRAPH RD

    DETROIT, MI 482193132

    Phone: (313) 531-2500

    Type: Location

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 48219)

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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: 0042289274View full group profile
NameSpecialtyState
Clinical PsychologistMI
Clinical Social WorkerMI
Clinical PsychologistCA
Mental Health CounselorMI
Mental Health CounselorMI
Mental Health CounselorMI
Mental Health CounselorMI
Clinical Social WorkerMI
Clinical Social WorkerIN
Clinical Social WorkerMI

Reviews

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Frequently asked questions

How is Unknown Individual identified in CMS data?
CMS-hosted NPPES data lists Unknown Individual with NPI 1629339858.
Why might Unknown Individual appear inactive while still practicing?
We display what the registry publishes: Unknown Individual appears inactive there.
What is Unknown Individual's specialty?
The listing groups Unknown Individual with Clinical Social Worker. Clinical services aligned with this taxonomy classification.
Where should I expect Unknown Individual on a map?
Expect Detroit, Michigan as a primary anchor for Unknown Individual unless the record lists multiple sites.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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