Unknown Individual – Clinical Child & Adolescent Psychologist, NPI 1578773479

Unknown Individual is a healthcare provider. based in Tallahassee, Florida. specializing in Clinical Child & Adolescent Psychologist. They hold a License No. PY0004347 (FL). The NPI Number for Unknown Individual is 1578773479

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1578773479
Phone
(850) 219-8848
Address
4636 INISHEER DR
Deactivation Date
20 December 2020
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience19
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 4636, Inisheer Drive, Tallahassee, Leon County, Florida, 32309, United States

    TALLAHASSEE, FL 323092446

    Phone: (850) 219-8848

    Fax: (850) 219-8848

    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 32309)

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Reviews

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Frequently asked questions

Can I use this page to confirm Unknown Individual's NPI?
Yes. Unknown Individual is listed with NPI 1578773479 in the public NPI dataset.
Is Unknown Individual excluded from programs when inactive?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What is Unknown Individual's primary classification?
Clinical Child & Adolescent Psychologist is the headline specialty for Unknown Individual here. Clinical services aligned with this taxonomy classification.
What area does Unknown Individual serve?
Unknown Individual's listing highlights Tallahassee, Florida; more addresses can appear in NPPES.
Is the information about Unknown Individual up to date?
Data updates when providers file changes in NPPES — treat critical facts as "verify if unsure."