Unknown Individual – Psychologist, NPI 1164454773

Unknown Individual is a healthcare provider. based in Lakewood, New Jersey. specializing in Psychologist. They hold a License No. PS00059L (PA). The NPI Number for Unknown Individual is 1164454773

Main info

Organization
Inactive
58 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1164454773
Phone
Not provided
Address
681 RIVER AVE STE 2E
Deactivation Date
26 June 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
2159478654
Graduation Year
1968 (58 years ago)
PAC ID
1153365283
Group Practice PAC ID
9335051085
Professional Enrollment ID
I20050620000161
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

  • 2, River Avenue, Seven Stars, Lakewood, Ocean County, New Jersey, 08701, United States

    LAKEWOOD, NJ 087015229

    Phone:

    Type: Mailing

  • 2109, Red Lion Road, Philadelphia, Philadelphia County, Pennsylvania, 19115, United States

    PHILADELPHIA, PA 191151711

    Phone: (732) 901-0035

    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 08701)

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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: 9335051085View full group profile
NameSpecialtyState
-PA
Mental Health CounselorPA
Clinical Social WorkerPA
Clinical PsychologistPA
Nurse PractitionerPA
-PA
Clinical Social WorkerPA
P S Y C H I A T R YPA
-PA
Clinical PsychologistPA

Reviews

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Frequently asked questions

Can I use this page to confirm Unknown Individual's NPI?
Yes. Unknown Individual is listed with NPI 1164454773 in the public NPI dataset.
Why might Unknown Individual appear inactive while still practicing?
We display what the registry publishes: Unknown Individual appears inactive there.
What is Unknown Individual best known for clinically?
Directory data describes Unknown Individual with Psychologist. Clinical services aligned with this taxonomy classification.
What address line appears for Unknown Individual?
Unknown Individual's geographic hint is Lakewood, New Jersey in our summary view.
Is the information about Unknown Individual up to date?
Data updates when providers file changes in NPPES — treat critical facts as "verify if unsure."

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