Active NPI
Peter G. Aubuchon, PH.D.
- Clinical Psychologist
- Bala Cynwyd, PA
National Provider Identifier
1336331669
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PS005094L
- Practice address
- 1 Bala Ave
Suite 230
Bala Cynwyd, PA 19004-3212 - Phone
- (610) 667-6055
- Fax
- (610) 667-5026
- NPI assigned
- Aug 10, 2007
- Last updated
- Aug 10, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PS005094L | PA | Primary |
Addresses
Primary practice location
1 Bala Ave
Suite 230
Bala Cynwyd, PA 19004-3212
Mailing address
1 Bala Ave
Suite 230
Bala Cynwyd, PA 19004-3212
Phone (610) 667-6055
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 1, 2025 through Apr 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS005094L | PA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1186704000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1186704000000",
"number": "1336331669",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 BALA AVE",
"address_2": "SUITE 230",
"city": "BALA CYNWYD",
"state": "PA",
"postal_code": "190043212",
"telephone_number": "610-667-6055",
"fax_number": "610-667-5026"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 BALA AVE",
"address_2": "SUITE 230",
"city": "BALA CYNWYD",
"state": "PA",
"postal_code": "190043212",
"telephone_number": "610-667-6055",
"fax_number": "610-667-5026"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AUBUCHON",
"first_name": "PETER",
"middle_name": "G.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-08-10",
"last_updated": "2007-08-10",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "PA",
"license": "PS005094L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bala Cynwyd, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.