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General NPI Number Information
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NPI Number | 1134633092
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Entity Type | Organization
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Legal Business Name | BERCAW NEUROPSYCHOLOGY
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Dates
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Enumeration Date | 11/29/2017
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Last Update Date | 04/20/2018
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Provider Practice Location Address
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Address Line | 710 OAKFIELD DR STE 153
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City | BRANDON
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State | FL
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Zip | 33511-4954
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Country | US
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Telephone | 813-603-7635
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Fax | 813-501-1186
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Provider Business Mailing Address
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Address Line | 710 OAKFIELD DR STE 153
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City | BRANDON
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State | FL
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Zip | 33511-4954
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Country | US
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Telephone | 813-603-7635
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Fax | 813-501-1186
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Authorized Official
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Title or Position | NEUROPSYCHOLOGIST
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Name | DR. EDWIN BERCAW
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Credential | PHD
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Telephone | 813-603-7635
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY7991
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | PY7991
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License Number State | FL
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