Unknown Individual – Child & Adolescent Psychiatry Physician, NPI 1184721979

Child & Adolescent Psychiatry Physician

Unknown Individual is a healthcare provider. based in Chester, Pennsylvania. specializing in Child & Adolescent Psychiatry Physician. They hold a License No. MD009105E (PA). The NPI Number for Unknown Individual is 1184721979

Main info

Organization

Inactive

61 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1184721979

Phone

(610) 497-7548

Address

2602 W 9TH ST

Deactivation Date

15 July 2022

Doctor Profile

Medical School Name

GEORGE WASHINGTON UNIVERSITY SCHOOL OF MEDICINE

Secondary Phone

6103889225

Graduation Year

1965 (61 years ago)

PAC ID

5092712950

Group Practice PAC ID

8729992458

Professional Enrollment ID

I20100611000263

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

2602, West 9th Street, South Chester, Chester, Delaware County, Pennsylvania, 19013, United States
CHESTER, PA 190132040
Phone: (610) 497-7548
Fax: (670) 497-7525
Type: Mailing
The Boulevard, Riverlights, Little Chester, Derby, East Midlands, England, DE1 2BB, United Kingdom
CHESTER, PA 190133902
Phone: (610) 874-5257
Fax: (610) 874-7241
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 19013)

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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: 8729992458View full group profile

Name	Specialty	State
MRS. MICHELLE LYNN REED (FNP-C)	Nurse Practitioner	PA
ELIZABETH SWIERCZEK (LPC)	Mental Health Counselor	DE
DR. DEEPAK S MAHAJAN (MD)	P S Y C H I A T R Y	PA
DR. TENESA RIVERA JEFFRESS (MD)	P S Y C H I A T R Y	PA
MS. LISA KATHERINE WOOD (L.C.S.W.)	Clinical Social Worker	PA
MS. KELLY LEMMON TUTURICE (LCSW)	-	PA
CHARLEEN GONDEN (CRNP)	Nurse Practitioner	PA
BETHANY DUDASH (PSY.D.)	-	PA
LESLIE WALTER CHERNYKH	Mental Health Counselor	NJ
ADELOLA ADEKUNLE (FNP-C)	Nurse Practitioner	PA

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Frequently asked questions

Can I cross-check Unknown Individual using NPI 1184721979?

NPI 1184721979 belongs to Unknown Individual; compare other details if you need extra assurance.

Can Unknown Individual still bill if the NPI is inactive?

Do not rely on inactive status alone — contact the provider for confirmation.

What kind of doctor is Unknown Individual?

Unknown Individual is associated with Child & Adolescent Psychiatry Physician in the directory — Clinical services aligned with this taxonomy classification.

Is Unknown Individual associated with Chester?

Public fields place Unknown Individual around Chester, Pennsylvania. Always confirm the exact site before visiting.

When was this NPI issued?

Enumeration for Unknown Individual is noted as not shown in this record where the registry provides it.