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General NPI Number Information
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NPI Number | 1952597023
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Entity Type | Organization
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Legal Business Name | ANNE MARIE BERCIK PHD PA
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Dates
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Enumeration Date | 09/21/2007
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Last Update Date | 10/11/2007
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Provider Practice Location Address
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Address Line | 202 QUAYSIDE CIR #202
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City | MAITLAND
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State | FL
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Zip | 32751-5771
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Country | US
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Telephone | 407-719-3616
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Fax |
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Provider Business Mailing Address
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Address Line | 202 QUAYSIDE CIRCLE #202
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City | MAITLAND
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State | FL
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Zip | 32751-5773
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Country | US
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Telephone | 407-539-1783
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANNE MARIE BERCIK
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Credential | PHD
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Telephone | 407-539-1783
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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