Provider Demographics
NPI:1407873144
Name:BERCIK, ANNE-MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANNE-MARIE
Middle Name:
Last Name:BERCIK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 QUAYSIDE CR
Mailing Address - Street 2:#202
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751
Mailing Address - Country:US
Mailing Address - Phone:407-719-3616
Mailing Address - Fax:
Practice Address - Street 1:2075 LOCH LOMOND DR
Practice Address - Street 2:MANER CARE NURSING & REHABILITATION CENTER
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792
Practice Address - Country:US
Practice Address - Phone:407-628-5418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3801103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73530Medicare ID - Type Unspecified