Unknown Individual – Clinical Social Worker, NPI 1053465856

Clinical Social Worker

Unknown Individual is a healthcare provider. based in Atlantic city, New Jersey. specializing in Clinical Social Worker. They hold a License No. 44SC04797700 (NJ). The NPI Number for Unknown Individual is 1053465856

Main info

Organization

Inactive

47 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1053465856

Phone

(609) 572-9178

Address

215 GRAMMERCY PL

Deactivation Date

9 January 2025

Doctor Profile

Medical School Name

OTHER

Secondary Phone

6093833330

Graduation Year

1979 (47 years ago)

PAC ID

4082661715

Group Practice PAC ID

1456368489

Professional Enrollment ID

I20050405001068

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

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Provider Addresses for Unknown Individual

Grammercy Place, Uptown, Inlet, Atlantic City, Atlantic County, New Jersey, 08401, United States
ATLANTIC CITY, NJ 084015555
Phone: (609) 572-9178
Type: Mailing
3073, English Creek Avenue, The Pines at English Creek, Egg Harbor Township, Atlantic County, New Jersey, 08234, United States
EGG HARBOR TOWNSHIP, NJ 082349711
Phone: (609) 569-0239
Fax: (609) 569-1942
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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCS	Description	Services	Beneficiaries	Medicare allowed
90834	Psychotherapy, 45 minutes	309	33	$0
90791	Psychiatric diagnostic evaluation	19	18	$0

View full utilization report →

Insurance plans in this area (ZIP 08401)

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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: 1456368489View full group profile

Name	Specialty	State
MR. BILLIE BYRON BENTON (LCSW)	-	NJ
MR. LEWIS PRESTON MOORE (LCSW)	Clinical Social Worker	NJ
MR. MATTHEW CHARLES REMINGTON	Clinical Social Worker	NJ
MS. GAY-ANN ROGGE-SETTANNI (LCSW)	Clinical Social Worker	NJ
RITA R. KAMMIEL (MD)	P S Y C H I A T R Y	NJ
JULIA LYNN HANKERSON (LCSW)	-	NJ