Unknown Individual – Clinical Social Worker, NPI 1205815651

Unknown Individual is a healthcare provider. based in Canton, Ohio. specializing in Clinical Social Worker. They hold a License No. I10285 (OH). The NPI Number for Unknown Individual is 1205815651

Main info

Organization
Inactive
45 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1205815651
Phone
(330) 453-8252
Address
625 CLEVELAND AVE NW
Deactivation Date
27 April 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3304550374
Graduation Year
1981 (45 years ago)
PAC ID
3971521410
Group Practice PAC ID
9335110824
Professional Enrollment ID
I20051103000589
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

  • 625, Cleveland Avenue Northwest, Upper Downtown Canton Historic District, Canton, Stark County, Ohio, 44702, United States

    CANTON, OH 447021805

    Phone: (330) 453-8252

    Fax: (330) 453-6716

    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 44702)

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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: 9335110824View full group profile
NameSpecialtyState
Nurse PractitionerOH
-OH
Mental Health CounselorOH
Nurse PractitionerOH
Mental Health CounselorOH
-OH
Mental Health CounselorOH
Nurse PractitionerOH
Mental Health CounselorOH
Mental Health CounselorOH

Reviews

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Frequently asked questions

Does Unknown Individual have a public NPI I can cite?
Public records show Unknown Individual under NPI 1205815651.
Should I call the clinic if Unknown Individual is inactive here?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
How should patients interpret Unknown Individual's specialty?
The extract shows Clinical Social Worker for Unknown Individual. Clinical services aligned with this taxonomy classification.
What geographic area is tied to Unknown Individual?
Unknown Individual is associated with Canton, Ohio in the same public data insurers reference.
Can I verify credentials using only NPI?
NPI confirms identity in the directory; licensure and board certification require separate checks.

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