Individual
DR. JAIME BERCUSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., PSY.D.
Contact information
Practice address
1389 CENTER DR STE 200, PARK CITY, UT 84098-7660
(727) 451-9223
Mailing address
1389 CENTER DR STE 200, PARK CITY, UT 84098-7660
(727) 451-9223
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
10389140-2501
UT
103TC0700X
Clinical Psychologist
PSY26093
CA
103TC0700X
Clinical Psychologist
PY8969
FL
Other
Enumeration date
08/24/2009
Last updated
11/10/2020
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