Provider Demographics
NPI:1114040599
Name:MORETTI, CHERYL L (LCMT)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:L
Last Name:MORETTI
Suffix:
Gender:F
Credentials:LCMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 CURTIS ST
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-1826
Mailing Address - Country:US
Mailing Address - Phone:401-944-8587
Mailing Address - Fax:
Practice Address - Street 1:236 WARWICK AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02905-2513
Practice Address - Country:US
Practice Address - Phone:401-491-2310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMT198174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist