Unknown Individual – Clinical Psychologist, NPI 1548236847

Unknown Individual is a healthcare provider. based in Roanoke, Virginia. specializing in Clinical Psychologist. They hold a License No. 0810-001962 (VA). The NPI Number for Unknown Individual is 1548236847

Main info

Organization
Inactive
38 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1548236847
Phone
(540) 981-7097
Address
2017 JEFFERSON ST SW
Deactivation Date
19 December 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
5409817000
Graduation Year
1988 (38 years ago)
PAC ID
8325002926
Group Practice PAC ID
9830096585
Professional Enrollment ID
I20041115000040

Contacts

Secure Messaging
rseidel19579@direct.carilionclinic.org
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness85
Years active:0State licenses:1Other namesUpdated within 12 months

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Provider Addresses for Unknown Individual

  • Jefferson Street, Roanoke Rapids, Halifax County, North Carolina, 27870, United States

    ROANOKE, VA 240142419

    Phone: (540) 981-7097

    Type: Location

  • 5332, Doe Run Road, Chesterfield, Cave Spring, Roanoke County, Virginia, 24018, United States

    ROANOKE, VA 240144933

    Phone:

    Type: Mailing

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 24014)

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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: 9830096585View full group profile

Reviews

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Frequently asked questions

Is Unknown Individual listed with a National Provider Identifier?
Yes — Unknown Individual has NPI 1548236847 on file in the registry.
Is Unknown Individual still active if the NPI shows inactive?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
What area of care is associated with Unknown Individual?
Unknown Individual's record emphasizes Clinical Psychologist. Clinical services aligned with this taxonomy classification.
What practice footprint exists for Unknown Individual?
Travel planning: use Roanoke, Virginia as the reference point for Unknown Individual, then confirm.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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