Provider Demographics
NPI:1053929562
Name:MOCERI, CATHERINE GABRIELLE
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:GABRIELLE
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 1:571 LAKE ASHLEY CIR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-1984
Mailing Address - Country:US
Mailing Address - Phone:772-380-5632
Mailing Address - Fax:
Practice Address - Street 1:5500 MURRELL RD UNIT 100
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-6700
Practice Address - Country:US
Practice Address - Phone:321-426-7759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-21
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLI526-127-00-594-0106S00000X
FLM260127005940106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician