Unknown Individual – Clinical Psychologist, NPI 1043215122

Unknown Individual is a healthcare provider. based in Maineville, Ohio. specializing in Clinical Psychologist. They hold a License No. 4243 (OH). The NPI Number for Unknown Individual is 1043215122

Main info

Organization
Inactive
38 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1043215122
Phone
(513) 981-0908
Address
8309 MARIGOLD LN
Deactivation Date
3 May 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
-
Graduation Year
1988 (38 years ago)
PAC ID
4385626324
Professional Enrollment ID
I20040607000921
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

  • 8309 MARIGOLD LN

    MAINEVILLE, OH 450399542

    Phone: (513) 981-0908

    Fax: (513) 779-9209

    Type: Mailing

  • Tylers Place Boulevard, The Lofts at Wetherington, West Chester Township, Butler County, Ohio, 45069, United States

    STE 2

    WEST CHESTER, OH 450696393

    Phone: (513) 779-3888

    Fax: (513) 779-9209

    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.

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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 45039)

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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 1043215122.
Is Unknown Individual excluded from programs when inactive?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What healthcare role does Unknown Individual hold?
Scheduling teams often label Unknown Individual under Clinical Psychologist. Clinical services aligned with this taxonomy classification.
What area does Unknown Individual serve?
Unknown Individual's listing highlights Maineville, Ohio; more addresses can appear in NPPES.
How many locations tie to this NPI?
2 practice locations appear in the available data.

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