Provider Demographics
NPI:1952597023
Name:ANNE MARIE BERCIK PHD PA
Entity Type:Organization
Organization Name:ANNE MARIE BERCIK PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANNE MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERCIK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:407-539-1783
Mailing Address - Street 1:202 QUAYSIDE CIRCLE
Mailing Address - Street 2:#202
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-5773
Mailing Address - Country:US
Mailing Address - Phone:407-539-1783
Mailing Address - Fax:
Practice Address - Street 1:202 QUAYSIDE CIR
Practice Address - Street 2:#202
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-5771
Practice Address - Country:US
Practice Address - Phone:407-719-3616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty