Provider Demographics
NPI:1831491497
Name:BERCOVICI, JON (LCSW)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:BERCOVICI
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 PROSPECT AVE
Mailing Address - Street 2:APT 14 I
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-2210
Mailing Address - Country:US
Mailing Address - Phone:201-446-6880
Mailing Address - Fax:
Practice Address - Street 1:62 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-8562
Practice Address - Country:US
Practice Address - Phone:201-546-7425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC000200001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical