Provider Demographics
NPI:1871820233
Name:BERCAW, EDWIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:
Last Name:BERCAW
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3818 67TH TER E
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-4009
Mailing Address - Country:US
Mailing Address - Phone:941-225-5309
Mailing Address - Fax:
Practice Address - Street 1:710 OAKFIELD DR STE 153
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4954
Practice Address - Country:US
Practice Address - Phone:813-603-7635
Practice Address - Fax:813-501-1186
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-05
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7991103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist