Unknown Individual – Clinical Child & Adolescent Psychologist, NPI 1750458899

Unknown Individual is a healthcare provider. based in Brooklyn center, Minnesota. specializing in Clinical Child & Adolescent Psychologist. They hold a License No. LP0466 (MN). The NPI Number for Unknown Individual is 1750458899

Main info

Organization
Inactive
47 Years Of Experience
Name
Unknown Individual
NPI
1750458899
Phone
(763) 531-0566
Address
6120 EARLE BROWN DR
Deactivation Date
2 January 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7635310566
Graduation Year
1979 (47 years ago)
PAC ID
6002817020
Group Practice PAC ID
3870545668
Professional Enrollment ID
I20070118000049
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience24
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 6120, Earle Brown Drive, Brooklyn Center, Hennepin County, Minnesota, 55430, United States

    SUITE 520

    BROOKLYN CENTER, MN 554302123

    Phone: (763) 531-0566

    Fax: (763) 531-0602

    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 55430)

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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: 3870545668View full group profile
NameSpecialtyState
Clinical PsychologistMN
Clinical PsychologistMN
Marriage And Family TherapistMN
Clinical PsychologistMN
Clinical Social WorkerMN

Reviews

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Frequently asked questions

What NPI should I save for Unknown Individual?
Save NPI 1750458899 if you need a stable reference for Unknown Individual.
How do I interpret inactive records for Unknown Individual?
Treat inactive as a signal to verify Unknown Individual through official channels.
Does Unknown Individual list a primary specialty?
If you are matching referrals, note Clinical Child & Adolescent Psychologist for Unknown Individual. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual's primary listing?
We display Brooklyn Center, Minnesota because that is what the record indicates for Unknown Individual.
Is Unknown Individual a real provider?
This page reflects official NPPES data for NPI 1750458899. Always confirm identity and privileges with the practice and licensing boards.

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