Healthcare Provider Details

I. General information

NPI: 1013904309
Provider Name (Legal Business Name): PETER A MOSBACH PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

468 GREAT RD
ACTON MA
01720-4187
US

IV. Provider business mailing address

468 GREAT RD
ACTON MA
01720-4102
US

V. Phone/Fax

Practice location:
  • Phone: 978-635-0509
  • Fax: 603-415-3521
Mailing address:
  • Phone: 978-635-0509
  • Fax: 603-415-3521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4495
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number4495
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number4495
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: