Organization
BERCAW NEUROPSYCHOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWIN BERCAW PHD (NEUROPSYCHOLOGIST)
(813) 603-7635
Entity
Organization
Contact information
Practice address
710 OAKFIELD DR STE 153, BRANDON, FL 33511-4954
(813) 603-7635
(813) 501-1186
Mailing address
710 OAKFIELD DR STE 153, BRANDON, FL 33511-4954
(813) 603-7635
(813) 501-1186
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PY7991
FL
103TC0700X
Clinical Psychologist
PY7991
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5932X
FLORIDA BLUE
FL
Enumeration date
11/29/2017
Last updated
04/20/2018
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