Unknown Individual – Clinical Social Worker, NPI 1538150479

Clinical Social Worker

Unknown Individual is a healthcare provider. based in Dayton, Ohio. specializing in Clinical Social Worker. They hold a License No. 081026 (OH). The NPI Number for Unknown Individual is 1538150479

Main info

Organization

Inactive

23 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1538150479

Phone

(937) 734-8333

Address

601 S EDWIN C MOSES BLVD

Deactivation Date

29 November 2023

Doctor Profile

Medical School Name

OHIO STATE UNIVERSITY COLLEGE OF MEDICINE

Secondary Phone

9374407121

Graduation Year

2003 (23 years ago)

PAC ID

2668694498

Group Practice PAC ID

0244148625

Professional Enrollment ID

I20141112000642

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience27

Completeness75

Years active:0State licenses:3Digital endpointsOther names

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Provider Addresses for Unknown Individual

601, South Edwin C. Moses Boulevard, Dayton, Montgomery County, Ohio, 45402, United States
SAMARITAN BEHAVIORAL HEALTH, INC.
DAYTON, OH 454173424
Phone: (937) 734-8333
Fax: (937) 734-4343
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.

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

HCPCS	Description	Services	Beneficiaries	Medicare allowed
90785	Psychiatric services complicated by communication factor	107	14	$0

View full utilization report →

Insurance plans in this area (ZIP 45417)

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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: 0244148625View full group profile

Name	Specialty	State
JAIME AARON (LPCC)	Mental Health Counselor	OH
JULIANA L BARLOWE (LPCC)	Mental Health Counselor	OH
HEATHER R GOUDY (CT)	Mental Health Counselor	OH
ANGELA KIMBALL (CT)	Mental Health Counselor	OH
DESTRY LLOYD EAST (D.O.)	-	OH
HOPE ELIZABETH MAUPIN	Mental Health Counselor	OH
DR. BERTILIA M TOCA (MD)	P S Y C H I A T R Y	OH
AMANDA BOYKIN	Nurse Practitioner	OH
ANGELA OKAN (LPCC)	Mental Health Counselor	OH
MRS. MARTHA HARRIS-LUKEN (MS LSW CCDC111)	Mental Health Counselor	OH