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General NPI Number Information
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NPI Number | 1821148289
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Entity Type | Individual
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Provider Name | JAMES MICHAEL BERCOVITZ PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 10/05/2010
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Provider Practice Location Address
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Address Line | 189 MAIN ST STE 203
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City | ONEONTA
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State | NY
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Zip | 13820-2580
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Country | US
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Telephone | 607-436-9159
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Fax |
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Provider Business Mailing Address
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Address Line | 67 EAST ST
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City | ONEONTA
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State | NY
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Zip | 13820-1627
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Country | US
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Telephone | 607-436-9159
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 011359
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 011359
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License Number State | NY
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