Provider Demographics
NPI:1447515226
Name:BERCAW, WILLIAM (PSYD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:BERCAW
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S LAKE AVE
Mailing Address - Street 2:#506
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-3955
Mailing Address - Country:US
Mailing Address - Phone:626-396-9306
Mailing Address - Fax:
Practice Address - Street 1:600 S LAKE AVE
Practice Address - Street 2:#506
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-3955
Practice Address - Country:US
Practice Address - Phone:626-396-9306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18848103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical