Unknown Individual – Clinical Psychologist, NPI 1053461616

Unknown Individual is a healthcare provider. based in San antonio, Texas. specializing in Clinical Psychologist. They hold a License No. 2-0747 (TX). The NPI Number for Unknown Individual is 1053461616

Main info

Organization
Inactive
55 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1053461616
Phone
(210) 828-1573
Address
5721 BROADWAY ST
Deactivation Date
20 December 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
-
Graduation Year
1971 (55 years ago)
PAC ID
0840345005
Professional Enrollment ID
I20120529000229
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience28
Completeness75
Years active:0State licenses:2Digital endpointsOther names

Provider Addresses for Unknown Individual

  • 5721 BROADWAY ST

    SAN ANTONIO, TX 782095701

    Phone: (210) 828-1573

    Fax: (210) 828-1993

    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.

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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.

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

HCPCSDescriptionServicesBeneficiariesMedicare allowed
90834Psychotherapy, 45 minutes20713$0
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Insurance plans in this area (ZIP 78209)

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Reviews

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Frequently asked questions

What federal number belongs to Unknown Individual?
The federal identifier for Unknown Individual is NPI 1053461616.
Is Unknown Individual's inactive status permanent?
An inactive NPI does not by itself prove someone stopped practicing — check other sources.
Does Unknown Individual list a primary specialty?
If you are matching referrals, note Clinical Psychologist for Unknown Individual. Clinical services aligned with this taxonomy classification.
Where does public data place Unknown Individual?
The snapshot lists San Antonio, Texas for Unknown Individual; download NPPES for the complete set.
What if San Antonio, Texas seems incomplete?
Street-level detail can be omitted — open the full address list for this NPI.

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