Provider Demographics
NPI:1851692099
Name:BERCAW, GEORGE HENRY (MA)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:HENRY
Last Name:BERCAW
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 NORTH CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3848
Mailing Address - Country:US
Mailing Address - Phone:423-309-1798
Mailing Address - Fax:423-893-0374
Practice Address - Street 1:1145 N CONCORD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3848
Practice Address - Country:US
Practice Address - Phone:423-309-1798
Practice Address - Fax:423-893-3374
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPE0000000322103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical