Provider Demographics
NPI:1316445919
Name:MAUCERI, JESSICA ANNE
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:ANNE
Last Name:MAUCERI
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 1:113 W MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:BOUND BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08805-1735
Mailing Address - Country:US
Mailing Address - Phone:908-300-1385
Mailing Address - Fax:
Practice Address - Street 1:113 W MAPLE AVE
Practice Address - Street 2:
Practice Address - City:BOUND BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08805-1735
Practice Address - Country:US
Practice Address - Phone:908-300-1385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist