Unknown Individual – Mental Health Counselor, NPI 1104993518

Unknown Individual is a healthcare provider. based in Waltham, Massachusetts. specializing in Mental Health Counselor. They hold a License No. 805 (MA). The NPI Number for Unknown Individual is 1104993518

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1104993518
Phone
(781) 647-5674
Address
180C RIVER ST APT 9
Deactivation Date
5 June 2025
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

Provider Addresses for Unknown Individual

  • 180C RIVER ST APT 9

    WALTHAM, MA 024536567

    Phone: (781) 647-5674

    Type: Mailing

  • 675 MAIN ST REAR

    WALTHAM, MA 024536354

    Phone: (339) 206-4477

    Type: Location

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.

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Medicare Enrollment & Revalidation

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No Medicare enrollment or revalidation data available for this provider in our database.

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Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

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No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 02453)

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Reviews

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Frequently asked questions

Where can patients find Unknown Individual's NPI?
You can confirm Unknown Individual with NPI 1104993518; it appears in the national provider directory.
Is Unknown Individual's inactive status permanent?
An inactive NPI does not by itself prove someone stopped practicing — check other sources.
Can you summarize Unknown Individual's specialty in plain language?
Clinically, the directory lists Unknown Individual with Mental Health Counselor. Clinical services aligned with this taxonomy classification.
What location metadata exists for Unknown Individual?
The page summarizes Waltham, Massachusetts for Unknown Individual; expand the address list for detail.
Does Medicare enrollment show here?
Medicare enrollment screens are separate from the basic NPI extract shown here.

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