Healthcare Provider Details

I. General information

NPI: 1912996992
Provider Name (Legal Business Name): STUSRT S MOSKOWITZ MA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 HIGHLAND ST
WORCESTER MA
01602-2143
US

IV. Provider business mailing address

338 HIGHLAND ST
WORCESTER MA
01602-2143
US

V. Phone/Fax

Practice location:
  • Phone: 508-752-5880
  • Fax: 508-831-9967
Mailing address:
  • Phone: 508-752-5880
  • Fax: 508-831-9967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number131
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number210
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: