Unknown Individual – Clinical Social Worker, NPI 1104910132

Unknown Individual is a healthcare provider. based in Glen mills, Pennsylvania. specializing in Clinical Social Worker. They hold a License No. CW012783 (PA). The NPI Number for Unknown Individual is 1104910132

Main info

Organization
Inactive
33 Years Of Experience
Name
Unknown Individual
NPI
1104910132
Phone
(610) 892-3800
Address
1204 HOLLY LANE
Deactivation Date
22 September 2021

Doctor Profile

Medical School Name
OTHER
Secondary Phone
6108923800
Graduation Year
1993 (33 years ago)
PAC ID
3870776008
Group Practice PAC ID
2668436692
Professional Enrollment ID
I20110325000581
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

Provider Addresses for Unknown Individual

  • 1204 HOLLY LANE

    GLEN MILLS, PA 19342

    Phone: (610) 892-3800

    Fax: (484) 468-1412

    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 19342)

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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: 2668436692View full group profile
NameSpecialtyState
Nurse PractitionerPA
Mental Health CounselorPA
P S Y C H I A T R YPA
Nurse PractitionerPA
-PA
Mental Health CounselorPA
Mental Health CounselorPA
-PA
Mental Health CounselorPA
Mental Health CounselorPA

Reviews

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Frequently asked questions

Where can patients find Unknown Individual's NPI?
You can confirm Unknown Individual with NPI 1104910132; it appears in the national provider directory.
How do I interpret inactive records for Unknown Individual?
Treat inactive as a signal to verify Unknown Individual through official channels.
Does Unknown Individual list a primary specialty?
If you are matching referrals, note Clinical Social Worker for Unknown Individual. Clinical services aligned with this taxonomy classification.
Does Unknown Individual practice in Pennsylvania?
You will see Glen Mills, Pennsylvania on file for Unknown Individual alongside any extra practice locations.
What if Glen Mills, Pennsylvania seems incomplete?
Street-level detail can be omitted — open the full address list for this NPI.

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