Unknown Individual – Psychiatry Physician, NPI 1043220056

Unknown Individual is a healthcare provider. based in Burlington, Vermont. specializing in Psychiatry Physician. They hold a License No. 042-0010033 (VT). The NPI Number for Unknown Individual is 1043220056

Main info

Organization
Inactive
43 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1043220056
Phone
(802) 865-3450
Address
86 LAKE ST
Deactivation Date
27 December 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
8028653450
Graduation Year
1983 (43 years ago)
PAC ID
1658532411
Professional Enrollment ID
I20120423000346
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

  • 86, Lake Street, Waterfront, Burlington, Chittenden County, Vermont, 05401, United States

    BURLINGTON, VT 054015297

    Phone: (802) 865-3450

    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 05401)

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Provider's Procedures

Unknown Individual performs procedures in Psychiatry Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
PSYCHIATRYVT90836Psychotherapy, 45 minutes with patient and/or family member6113

Reviews

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Frequently asked questions

How do I look up Unknown Individual by NPI?
Use NPI 1043220056 when you need to reference Unknown Individual in forms, claims, or directories.
What is the next step if Unknown Individual is inactive?
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 Psychiatry Physician for Unknown Individual. Clinical services aligned with this taxonomy classification.
What location metadata exists for Unknown Individual?
The page summarizes Burlington, Vermont for Unknown Individual; expand the address list for detail.
Is Unknown Individual a real provider?
This page reflects official NPPES data for NPI 1043220056. Always confirm identity and privileges with the practice and licensing boards.

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