Provider Demographics
NPI:1891721510
Name:MORETTI, JILL (PCNS)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:MORETTI
Suffix:
Gender:F
Credentials:PCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 229
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02880-0229
Mailing Address - Country:US
Mailing Address - Phone:401-788-3337
Mailing Address - Fax:401-788-3939
Practice Address - Street 1:70 KENYON AVE
Practice Address - Street 2:SUITE 326
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-4239
Practice Address - Country:US
Practice Address - Phone:401-788-1277
Practice Address - Fax:401-788-1514
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPPNS00031163WP0808X
RIAPRN363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI05-0468084OtherUNITED HEALTH PLANS
RI406676OtherCOORDINATED HEALTH PLANS
RI30553-6OtherBLUE CROSS & BLUE SHIELD
RIP00302348OtherRAILROAD MEDICARE
RI05-0468084OtherUNITED HEALTH PLANS