Provider Demographics
NPI:1063042265
Name:MOCERI, LIA MARIE
Entity Type:Individual
Prefix:
First Name:LIA
Middle Name:MARIE
Last Name:MOCERI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CROSSINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-2878
Mailing Address - Country:US
Mailing Address - Phone:401-777-7000
Mailing Address - Fax:
Practice Address - Street 1:330 BROOKLINE AVE # 10
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5400
Practice Address - Country:US
Practice Address - Phone:617-667-3940
Practice Address - Fax:317-667-2155
Is Sole Proprietor?:No
Enumeration Date:2020-01-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA390200000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program