Unknown Individual – Clinical Psychologist, NPI 1124016621

Unknown Individual is a healthcare provider. based in Tamarac, Florida. specializing in Clinical Psychologist. They hold a License No. PY5078 (FL). The NPI Number for Unknown Individual is 1124016621

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1124016621
Phone
(954) 720-4416
Address
8205 NW 71ST AVE
Deactivation Date
8 November 2024
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience24
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 8205, Northwest 71st Avenue, Tamarac, Broward County, Florida, 33321, United States

    TAMARAC, FL 333215093

    Phone: (954) 720-4416

    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 33321)

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Reviews

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Frequently asked questions

How is Unknown Individual identified in CMS data?
CMS-hosted NPPES data lists Unknown Individual with NPI 1124016621.
What dates should I check for Unknown Individual's activity?
We display what the registry publishes: Unknown Individual appears inactive there.
What healthcare role does Unknown Individual hold?
Scheduling teams often label Unknown Individual under Clinical Psychologist. Clinical services aligned with this taxonomy classification.
Does Unknown Individual list a practice location?
Patients near Tamarac, Florida may find Unknown Individual in results; validate coverage separately.
How many locations tie to this NPI?
2 practice locations appear in the available data.

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