Unknown Individual – Mental Health Counselor, NPI 1104915172

Unknown Individual is a healthcare provider. based in Gloucester, Massachusetts. specializing in Mental Health Counselor. They hold a License No. 5678 (MA). The NPI Number for Unknown Individual is 1104915172

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1104915172
Phone
(978) 430-9965
Address
128 MAIN ST.
Deactivation Date
9 May 2022
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

  • 128;130;132;134, Main Street, Central Gloucester Historic District, Five Pound Island, Gloucester, Essex County, Massachusetts, 01930, United States

    GLOUCESTER, MA 01930

    Phone: (978) 430-9965

    Fax: (978) 283-1604

    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 01930)

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Reviews

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Frequently asked questions

What unique ID ties claims to Unknown Individual?
NPI 1104915172 is assigned to Unknown Individual under the national enumeration system.
What is the next step if Unknown Individual is inactive?
Treat inactive as a signal to verify Unknown Individual through official channels.
What field does Unknown Individual work in?
You can think of Unknown Individual as practicing within Mental Health Counselor. Clinical services aligned with this taxonomy classification.
Where does public data place Unknown Individual?
The snapshot lists Gloucester, Massachusetts for Unknown Individual; download NPPES for the complete set.
How can I contact Unknown Individual?
Phone or fax may appear on the official NPI record when supplied — verify before relying on them.

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